Success Story: Deepak Hayer
*Names have been fictionalized to protect the privacy of our clients.
Deepak Hayer and his wife Sunita came to Sault Ste. Marie, Ontario from India when he was 29 years old. Already a civil engineer specializing in water supply management, Mr. Hayer had to fulfill Canadian requirements before he could work as an engineer in Canada. In the time it took to gain Canadian credentials, he drove a taxi.
Insurance for family security
Another measure the Hayers took to prepare for life in Canada was to insure him, the breadwinner. They bought life and critical illness policies. He never took his eyes off the goal of security for his family.
At the age of 46, Mr Hayer was practising as an engineer, involved in the Greater Toronto Area water supply. He and Sunita had a teenage son and daughter and the future looked bright. Yet, when a disabling heart attack occurred, his family discovered that the security of the critical illness insurance would require legal advocacy.
The heart attack followed an afternoon of playing soccer with the kids in a neighbourhood park. It left Mr. Hayer physically disabled and unable to speak clearly. When Sunita filed a critical illness claim, she found that she would not deal with the nice neighbour man who had sold the policy, but with investigators who treated her with skepticism and made no allowances for her challenges communicating about such matters in English. She had always relied on her husband to handle such things.
Claim denied on doctor's note to self
After a few weeks, Sunita received a letter from the insurer denying the claim. Her children helped her to interpret it. The insurance company’s investigation had found a note in Mr Hayer’s medical files. This note indicated that a blood test had shown his cholesterol levels at the high end of the normal range. In a note to herself, the doctor had written, “Watch cholesterol levels.” The insurance company found this an important indicator of heart attack risk. Its omission from the insurance application was their reason to deny the claim.
Application was bona fide
The Hayers’ daughter had an ambition to attend law school and believed that a good lawyer specializing in insurance disputes could fight the denial of benefi ts. After all, Sunita and Deepak had been careful to complete their insurance applications accurately. They could not have known that the family doctor had made a note to herself to watch Mr Hayer’s cholesterol levels. Besides, a cholesterol level at the high end of normal is not itself an indicator that a heart attack is likely.
Legal case accepted
On referral from a friend of the daughter’s, Sunita went to Share Lawyers. When she explained the reason given for the claim being denied and insisted that Mr Hayer had not been informed that his cholesterol level warranted any particular attention, Share Lawyers accepted the case.
Insurer sued successfully
Share Lawyers sued the insurance company. The Hayer family won the full payout on the basis that Mr Hayer was not aware of any concerns about his cholesterol when he applied for the policy, and therefore could not have omitted information that the doctor had simply written in a note to herself. The Hayers’ daughter has since applied to law school; their son to medical school. Sunita and Deepak are delighted.
Note: While in this case Share Lawyers recovered the total Critical Illness benefit, the outcome of any case depends on the relative strengths and weaknesses of the evidence. Total recovery is not always possible.
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