In a story that’s far too common, Montreal writer Samuel Archibald recently shared his story of what he called “abandonment by his insurer.” While away from work on leave to treat his depression, Archibald was unknowingly tracked on social media by his insurance company – and everyday simple information about his life was used against him to deny his health claim. Out for a run? He must not be depressed. Eating a meal with family? He must not be depressed. Or at least these are the hasty judgments that his insurer made about his mental health. Did they take into account that exercise can be a wonderful natural anti-depressant? Did they take into account that eating is necessary to survive, and spending time with family can be a healthy part of treatment and recovery? Were they even medically trained to make this type of conclusion, and if so, is it ethical to make this type of conclusion without actually treating a patient in person? The questions go on and on, and in Archibald’s outrage, he took pen to paper and brought light to a very complicated issue in the insurance world. If their job is to help people when they are sick and in need, why are they so often leaving people hanging? Why are they causing harm?
Insurance companies have a bad reputation for paying health claims, and here’s why – they have a long history of denying claims and leaving people in the dark. Leaving people confused. Leaving people in financial distress. Leaving people to suffer without the support they are entitled to.
So what’s the reasoning behind all the denials? The insurer has a bottom line – and unfortunately the bottom line is not your health and wellness. “It’s an insurance company that administers the plan, that decides on the claim, and ultimately has to foot the bill if the benefit is granted – and that’s a conflict of interest that everyone can easily see,” said Sean M. Anderson, a University of Illinois expert in employee benefit plan policy and regulation.
When insurance companies are not helping, when they are not paying for valid health claims, they are hurting people. They are leaving families in turmoil, finances in jeopardy, and the health of their insureds at risk. They are forcing people who are not healthy back into the workplace.
A huge gray area, and something that we see every day at Kantor & Kantor, is insurance denials for invisible illnesses. The part that makes everything a bit murky is the “invisibility” of so many illnesses. Mental illnesses, such as depression, anxiety, and eating disorders can be crippling to live with, and even life-threatening. Physical disabilities, such as rheumatoid arthritis, lupus, multiple sclerosis, and parkinson’s disease, can’t be easily detected just by looking at someone – but can be painful, life-altering, and completely debilitating. Here’s something you should understand about insurance companies: if you can’t see it, it’s very difficult to prove it exists. And if you don’t have evidence and documentation, it doesn’t exist to them.
When insurance companies deny claims, they don’t always remember that each insured is a person with a name, a person with a face, a person with a disability severe enough to interrupt and interfere with their life. Each insured is a person, and that is so often forgotten.
Archibald’s story reminds us of the individuality of each case, and the flaws that exist within the insurance claim process. His story shows us that calling insurers out on their negligence can not only help his particular case, but the cases of so many others in the same position. His story creates a voice for those that have been overlooked, and challenges the nature of wrongful insurance denials in both Canada and the U.S.
At Kantor & Kantor, we spend every working day fighting for our clients. If your health claim or long term disability insurance claim has been wrongfully denied, please contact our office for a no-cost consultation. We understand, and we can help.