Trouble getting claim file from insurance company

I sent a written notice to my insurance company trying to obtain a complete claim file but the case agent is only willing to send all my medical files to my doctor and will leave it to the doctor to decide to release to me or not. The agent said it is their policy and he has no such document to share with me. I still hope to get it directly sent to me as it takes the doctor too much time going through all past years files and I will be asked to book multiple appointments to go through with the doctor before I can get a copy (already confirmed with doctor).
I checked PIPEDA, and there is a section mentioned about sensitive medical information through medical practitioner.
What shall I do next for obtaining my own medical records directly sent to me. Thank you for your advice.

I had no problem getting my LTD case file and my policy from my insurer.

I just sent two separate written requests to my case manager about it. She told me to pay for printing and mailing services. And she sent everything to me by mail. My case file was hundreds of pages. Policy is very long too but she only sent me the part about LTD.

Who did you sent the request to?

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I’m guessing you were denied and need your file for an appeal?
I would get the free consult with resolute legal.

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Hi jammer: thanks for replying, no I am not denied, still being insured and on claim, but insurance company is on my back. Do you know if PIPEDA grants them rights for sending all medical files to doctors instead to me? I know once denied and not insured, obtaining files could be a bit difficult, but I am still on claim now.

hi Elaine, thanks for the reply. I sent my request for complete file to the senior manager already, who said it’s their company policy, also he cannot share me their policy about this. I already got my insurance policy no problem, but now having trouble for obtaining my medical file directly. PIPEDA has a paragraph talked about sensitive medical information, not sure if this is what he can go by and make my entire medical file as sensitive?

Well he is supposed to give you an access to your file.

Maybe it depends on the province. I usually have no problem getting medical files from any of my doctors.

There are a lot of posts on the forum about this. Did you have a chance to read them?

Thanks Elaine, the insurance company is located in Ontario, different province from where I reside, so I believe the PIPEDA applies instead of the provincial legislation?
I have read the related posts, didn’t find if under the law, they can just disclose all files to my doctor. It’s not realistic for my doctor going through for files for past many years, but my doctor said she has to, really damaging doctor-patient relationship of what they are doing.

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You should make it clear to the insurer that your request is an official PIPEDA request. This might involve making a new request that meets all the PIPEDA requirements.

If they continue to insist on limiting access and only sending to your doctor, then you can file a challenge through the privacy commissioner.


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.

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Thank you David so much for the great advice. I sent this manager a new request with PIPEDA mentioned and he agreed right away that all files to me directly!

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The games these companies play is ridiculous.

You just had to say the magic word. Knowledge is power.

Glad you are getting your file.

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You should have every right to see your own medical files and view the complete files and reports that the insurance company has on you. I never had any issue asking for and receiving this info from my insurance company (Great West Life). It might take longer than you would like but keep the pressure on them, like call them every week asking for it. They HAVE to provide it to you and include you in your PLAN and assessments. Not doing so is acting in bad faith.

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Exactly, magic word seemed worked, partially. Each step has been extremely difficult and frustrating. Thanks for this great Informative forum and everyone here is so supportive!

Help needed again on this matter please. I sent a PIPEDA official request and finally I got my files. However, I noticed the information since the new claim agent took over at beginning of the year is missing, which is the most important information as my case is being overly-active managed since he took over (scheduled IMEs, new forms, requests from doctor offices, reviews, possible surveillance- I can see lots are missing)

What can I do next in order to receive the most recent and complete files Up to Date? It will be third request if I send in again. What should I write on the request so the case manager doesn’t leave out information of the file that is happening in recent months?

Yes, make another request and make it specific to the time period in question and new case manager.

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