As a busy dance teacher, mother and wife, Jayne Williams had many responsibilities to fulfill on a daily basis. Maintaining good health and a balanced life were important to her, as was having a reliable financial protection plan in case she became ill. She purchased life and critical illness insurance coverage when her first child was born – about seven years prior to receiving a life-changing diagnosis.
During a routine breast exam, Jayne’s family physician detected a lump in her left breast and immediately ordered a biopsy. When the tests came back a week later, Jayne, at 46-years-old, was diagnosed with breast cancer.
Jayne had surgery to remove the tumour and began adjuvant chemotherapy. Due to the effects of chemo, Jayne had to stop working. She tried to remain positive. Knowing she had insurance coverage gave her the peace of mind to focus on getting through her physically and emotionally taxing cancer treatment.
She filed a claim with the insurance company for her $250,000 critical illness benefit. The insurance company responded to Jayne after many weeks, requesting her complete medical records.
After taking months to review Jayne’s claim, the insurance company sent her a letter stating that she had omitted medical information on her initial application for coverage. Due to this so-called misrepresentation, her policy was void. They included a cheque with their letter. It was a return of the premiums she had paid for the last seven years. Jayne felt crushed.
Her husband was working but they needed a second income, or in this case, her insurance benefit, to make ends meet. At one of the most challenging points in her life, she was faced with the disappointment and feelings of utter betrayal when her insurance safety net did not come through for her and her family.
Jayne retained Share Lawyers to take her case on a No Fees Unless We Win agreement and observed how swiftly and diligently the team of lawyers and law clerks began work on her file. Her anxiety slowly shifted into a feeling of hope. She knew it was just a matter of time before the insurance company would have to do the right thing.
The health information in question was a single line in Jayne’s medical records dated two years before she first purchased coverage. Her physician had noted that Jayne was experiencing symptoms indicative of Major Depressive Disorder. However, this was never relayed to Jayne and no testing or treatment was prescribed as her symptoms were later identified as acute stress.
Share Lawyers put forth a strong case using expert testimony from Jayne’s physician. They noted that the questions in the initial insurance application were ambiguous and open to interpretation. Furthermore, Jayne answered all the questions on her application honestly and to the best of her knowledge.
The mediation with the insurance company’s legal counsel was over quickly. The insurance company agreed to pay Jayne the full amount of her critical illness benefit. Jayne could continue her recovery without the added burden of outstanding bills. With her husband’s support and the benefit amount, Jayne fully recovered and has been cancer-free for over three years.
*All names and identifying details have been changed to protect the confidentiality of all involved.