Insurance Coverage Denied: When a Stroke Isn’t a Stroke
Insurance Coverage Denied: Read the Fine Print
Before accepting any insurance policy, you should always read the fine print! Often, insurers will use an exclusion clause that will lead to your application being stamped “coverage denied” during a difficult time in your life.
A woman in Calgary found herself in this exact situation.
Jennifer Wilson’s Story
Jennifer Wilson suffered a stroke during childbirth in March of 2011.
The injury has left her unable to work, which has greatly affected her ability to make her mortgage payments.
Wilson believed that her mortgage insurance policy through TD Insurance would protect her in this case, as strokes are listed as a covered medical issue.
However, TD Insurance denied her claim. The company stated that their policy covers only cerebrovascular strokes: her stroke affected the pituitary gland and not the brain itself.
Wilson has been fighting TD Insurance on this issue for the last three years of her life.
Insurance Policy Exclusions and Limitations
Insurance policies contain exclusions and limitations that people should be aware of! This is true of mortgage insurance, car insurance, home insurance, travel insurance, etc.
People are SHOCKED when they see the denial and often they give up rather than seek legal advice. Often it is possible to negotiate with the insurer or start legal action and get a fair settlement.
Exclusion clauses must be VERY specific in order for the insurance company to be able to rely on them. If an exclusion clause is vague, the law states that it MUST be interpreted AGAINST the insurer.
This means that often we can counter a denial by arguing that the insurer is wrong in its interpretation of the exclusion upon which it seeks to rely. Once we do that, the insurer is often reasonable in trying to reach a compromise/settlement. Contact us for a free disability consultation to learn more about your rights when your disability claim is denied.
Find the full story on Jennifer Wilson HERE via CTV News Calgary.
About the Author
Sivan Tumarkin
Sivan Tumarkin is a Founding Partner of Samfiru Tumarkin LLP and Practice Leader for the firm's Long-term Disability & Personal Injury Law Group. His previous experience working for insurance companies has given him unique insight into the long-term disability claim denial and appeals process, allowing him to secure strong results for his clients.
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