OLHI – OmbudService for Life & Health Insurance | Resolution of your Canadian Insurance Concerns | OLHI

Case Study

Under pressure (travel)

Mrs. T. purchased medical travel insurance ahead of a trip abroad. On that holiday, she fell ill and had to be treated in hospital. Afterward, she submitted her claim. It was declined because the insurance plan did not cover anyone who had been treated for three specific medical conditions. In its final position letter, the

An important conversation (life)

Mr. and Mrs. H. applied for life insurance and were approved. When her husband died several months later, Mrs. H. claimed the benefits under the policy. The insurance company denied the claim for failing to disclose information about Mr. H.’s health. Mrs. H. brought her final position letter to OLHI. She explained to our Dispute

“Help” vs. “coverage” (travel)

Mrs. R. frequently traveled out of country. She purchased a travel health insurance plan that would cover her for 35 days every time she left Canada. She departed in February and in May, while still on her holiday, she suffered a major illness, was hospitalized and passed away two weeks later. While Mrs. R. was

Conflicting medical reports (disability)

Ms. C. worked as an office administrator, a predominantly sedentary role. She began to experience medical conditions that affected her back. Her employer’s group disability insurance plan covered her short-term disability claim. After several months, the insurance company denied Ms. C.’s coverage for long-term disability (LTD), stating that her illness did not prevent her from

Automatic renewal (life)

Mrs. U. purchased life insurance in 2006. She explained to her agent that she only wanted a policy that would cover her for 10 years and that she planned to cancel when the term expired. She said she would not be able to afford the new premiums, which would rise dramatically after 10 years. Mrs.

Contra proferentem (life)

When Mr. N. purchased life insurance in 2000, he explained to his agent that he wanted to pay the same monthly premium for the lifetime of the policy. His agent helped him fill out an application and also provided him with illustrations to show how his premium would never change. Fifteen years later, Mr. N.’s

Payouts for life (annuity)

In the 1980s, Mr. A. purchased an annuity so that he and his wife would have a monthly income over the course of their lives. When one passed away, the annuity would continue to provide income to the surviving spouse. Mr. A. passed away in 2015 and, after this, payments stopped. The insurance company’s final

Revisiting an old claim (disability)

Ms. H. was injured in a work-related accident. For around 10 years, she received long-term disability (LTD) payments through her employer’s group benefits plan. After this time, the insurance company revisited her case, asking a doctor to perform an independent medical evaluation. The doctor found no functional impairment so Ms. H.’s benefits were terminated. Ms.

Submitting claims after you leave a job (health)

Ms. P. stopped working for her employer in April. For the next 90 days (until July), her employee benefits plan would accept any health expenses incurred before her last day of employment. Before she stopped working, Ms. P. saw a health practitioner. He sent a claim submission to the insurance company twice: once in April