Insurance claim denials leave some COVID-19 sufferers planning ‘for the worst’
Published Thursday, January 28, 2021 7:00AM ESTLast Updated Thursday, January 28, 2021 8:39AM EST
“A lot of employers have actually been really more tolerant of people’s post-COVID (situation),” said Daniel Lublin, a partner with employment law firm, Whitten & Lublin. It has been the insurance companies that have been more difficult, he noted.
“The amount of claims that are being denied are skyrocketing right now. This is a huge, huge problem where people are unable to get appropriate coverage.”
There is currently no data available to determine what the trends have been relating to COVID-19 claims, according to the Canadian Life and Health Insurance Association (CLHIA), the industry group to which insurance companies directed CTVNews.ca’s queries. The group also could not speak to specific claims, but a spokesperson said in an email that coverage is “generally based on an assessment of an individual’s condition and the requirements of their job.”
This is a new virus, there’s no history or precedence for it, several employment and disability lawyers told CTVNews.ca, and no one knows yet what this disease is going to be like in two years or over the long term. With policies differing from insurer to insurer, there are no easy or straightforward answers on why disability coverage might be denied, they add.
In some instances, employees are also placed in the difficult situation of being barred from returning to work by their employer due to COVID-19 concerns, but denied coverage by the insurance company while they are on leave, according to Oyelowo. It’s a tough situation, though not insurmountable, she said.
One insurance company that responded to CTVNews.ca’s queries regarding disability claims declined to comment on hypothetical or specific examples or cases, citing privacy considerations.
“We empathize with anyone who has lost a loved one to COVID, or who is struggling themselves with this new virus that has so many unknowns,” said Diane Bezdikian, a senior vice-president of plan member services with Canada Life, via email, adding that claims related to COVID-19 are assessed on a case-by-case basis, just like any other claim, in part due to varying plan coverages.
“Generally speaking, companies with Canada Life’s standard disability group coverage provide their plan members with a level of income replacement, for a specified time frame when they can’t work due to disease or injury. Plan members are eligible for disability benefits if they meet the plan’s definition of disability, including where disability is caused by COVID-19 infection.”
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