Share Perspectives : Issue 46, August 2014 - page 1

continued on page 2
IN PERSON:
Jey Rupasinghe
Doctor with End-Stage Liver
Disease Denied Critical Illness
Benefits
54-year-old Jey Rupasinghe was an
accomplished ophthalmologist, proud
husband and father whose family meant
everything to him. In order to protect
his family financially, he purchased
comprehensive health insurance that
included a critical illness benefit in the
amount of $250,000.
DIAGNOSED WITH LIVER DISEASE
Jey began to experience nausea, fatigue and
abdominal cramps on a regular basis. He
booked an appointment with his doctor when
he realized his symptoms weren’t getting
better. A blood exam identified that Jey’s liver
was not functioning normally. Further tests
helped diagnose Jey’s condition as fatty liver
disease. Jey’s doctor told him he needed to
make diet and lifestyle changes to reverse this
early stage of liver disease.
THREE YEARS LATER
By age 57, Jey’s condition had unfortunately
worsened, even though he had tried his best
to follow his doctor’s advice to change his
diet, cut out alcohol and exercise. Swelling
in his legs and abdomen, weakness and loss
of appetite caused him to take a permanent
leave from work. He was seeking regular
treatment, until one day, his specialist broke
the news that Jey’s liver disease was in a late
stage and the best prognosis would be from a
liver transplant.
PUT ON WAITING LIST
Jey was placed on a waiting list with one of
the country’s best transplant centres. His wife
and children rallied around him. Jey decided
it was time to submit a claim for his critical
illness benefit so that his family would be able
to keep up with their bills and other expenses.
INSURER DENIES CLAIM
Jey submitted extensive medical information
and filled out all the required paperwork the
insurance company requested. He survived
the 30-day waiting period after the date of
diagnosis of major organ failure. Even then,
the insurance company’s requests spanned six
more weeks and seemed endless. Finally, they
wrote back to Jey with a startling response:
while they acknowledged that Jey met the
criteria for major organ failure, on waiting list,
the claim was denied based on Jey’s failure to
provide information regarding another health
condition he had been suffering from when
he took out the insurance.
Jay was worried when his critical illness
benefit was denied for organ transplant.
ISSUE 21, AUTUMN 2011
THIS ISSUE
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Call (416) 488-9000 for your
free copy of Disability Benefits
Denied: What To Do When The
Insurance Company Denies
Your Disability Claim.
FREE DISABILITY
BOOKLET
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PERSPECTIVES
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ISSUE 46, AUGUST 2014
SETTLEMENTS
We have recently settled cases
with:
Meloche Monnex
Aviva
Intact Insurance
Canada Life
La Capitale and many more
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