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Disability Benefits Denied:
What To Do When The
Insurance Company Denies
Your Disability Claim
Chloe Baros had worked with a district school board in the Greater Toronto Area for 23 years. She took great pride in her job as a Sign Language Interpretor and enjoyed helping bright and talented high school students enhance their educational experience and improve their communication skills.
Shortly after turning 46-years-old, Chloe noticed that her eyesight wasn't as sharp as it used to be. She visited her optometrist, expecting that she needed new glasses. Her optometrist performed a routine eye exam and noticed some degeneration. He referred her to an ophthamologist, who diagnosed her with early onset macular degeneration.
This diagnosis didn't end Chloe's career until almost two years later. By that point, she had complete central vision loss in both eyes.
Chloe had two insurance policies: longterm disability through her group benefits at work, and a private critical illness policy she had purchased ten years ago. Chloe had never made a claim for any type of benefits. She assumed that after submitting the applications, her benefits would be deposited into her bank account.
After taking months to review her claim and full medical records, the insurance companies came back with their decision. Her LTD was approved; however, her critical illness claim was denied.
“The illness diagnosed does not meet the specific criteria outlined in the policy.” Chloe read that line of the letter over and over. She then pulled out the insurance policy. “Blindness means a definite diagnosis of the total and irreversible loss of vision in both eyes, evidenced by: the corrected visual acuity being 20/200 or less in both eyes; or, the field of vision being less than 20 degrees in both eyes. The diagnosis of blindness must be made by a specialist.” She met the criteria. So, she appealed their decision. When the insurer denied her once again, she knew something wasn’t right.continued on page 2