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.
Chloe did not waste any time consulting with Janice Grevler, an experienced insurance lawyer at Share Lawyers. Janice confirmed what Chloe felt in her gut-- her insurance carrier had found a technicality to deny the claim. Fortunately, Janice assured Chloe that Share Lawyers would be able to challenge their decision.
Share Lawyers worked diligently to build a strong case against the insurance company for denying Chloe's critical illness benefit once their lawyer showed an interest in discussing a resolution.
Their poor excuse for denying the claim was that the medical information provided by Chloe's ophthamologist was incorrectly evaluated by their in-house specialists and interpreted as not qualifying as “blindness” under the policy. The insurer showed a willingness to reconsider their decision once they got the message that their claimant meant business.
Chloe was relieved to have the lump-sum payment in her account as she prepared for an early retirement. Her disability had changed her life and presented many challenges that she now had to overcome. She was grateful not to have the added stress of keeping a roof over her head.
She retained Share Lawyers once again when her group insurance company cut her off of long-term disability benefits, and once again, Share Lawyers followed through on their commitment to protect her rights.
All names and identifying details have been changed to protect the confidentiality of all involved.