OLHI – Free, impartial help with your life & health insurance complaints Mike W. worked in construction all his life until he hurt his back.
Unable to work since his injury, he was declared “totally disabled” by the Régie des Rentes du Québec (“RRQ”).
The credit insurance Mike purchased when he took out his mortgage covered his monthly payments. In the event of disability, it would pay 150% of all mortgage-related expenses and waive all monthly premiums.
But after 12 months, the insurer stopped all payments and began charging Mike his monthly credit insurance premiums.
This was when Mike came to OLHI. He believed that his insurer should cover his remaining mortgage because the RRQ had confirmed he was “totally disabled”. His medical condition had not improved, and he thought he was unable to work.
We explained that disability benefits typically cover an initial period based on the inability to perform one’s own occupation. But for benefits to continue, Mike needed to show that he was unable to perform any occupation. The RRQ’s declaration that Mike was “totally disabled” did not necessarily prove that he was “unable to perform any occupation.”
We advised Mike to contact his insurer and formally ask for a review of his file.
Mike negotiated an agreement with his insurer to pay off his mortgage. In exchange he waived his entitlement to the additional 50% benefits and reimbursement of his credit insurance premiums.
Disclaimer: Names, places and facts have been modified in order to protect the privacy of the parties involved. This case study is for illustration purposes only. Each complaint OLHI reviews contains different facts and contract wording may vary. As a result, the application of the principles expressed here may lead to different results in different cases.