By: Samfiru Tumarkin
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TD Insurance denials criticized after customers come forward
TD Insurance denials criticized after others come forward
By Sean O’Shea
December 5, 2018
Bianca Williams isn’t the only TD Insurance customer who was recently denied critical insurance benefits.
After Williams’ story was published and aired by Global News, other TD Insurance customers came forward to say they had been denied benefits payments, too.
Williams, a 29-year-old nurse from Port Perry, Ont., developed two rare and serious blood disorders that require her to receive regular blood transfusions.
She says doctors have told her she needs chemotherapy, radiation and a bone marrow transplant in the new year. She says she’s been warned that she may have to be away from work for more than a year.
But TD Insurance denied her critical insurance claim, saying in a letter that her illness is not covered under the terms of the insurance policy.
She and her husband pay about $2,000 annually for coverage, which went into effect when they took out a mortgage about three years ago. The couple says they were assured by the sales representative that the mortgage payments would be made in the event that either of them could not work as a result of a serious illness or medical condition.
Mark Blackwell, of Carrying Place, Ont., has had a similar experience with the company. He was diagnosed with a brain tumour known as an ependymoma six weeks ago. It’s a rare type of tumour that was growing on his brain stem.
Doctors in Kingston spent eight hours removing as much of the tumour as possible. But they couldn’t get it all, he said. There are no other treatment options available.
“I thought it was pretty much a slam dunk when I filled out the paperwork,” said Blackwell, who has been unable to work for two months.
“I was denied…they needed more proof of growth of the tumour,” he said.
“Inevitably, aside from a miracle, it will grow back,” Blackwell added.
TD Bank Group told Global News it denied Blackwell’s claim because “the type of insurance the customer purchased only covers life-threatening cancer.”
“The claim underwent an independent medical evaluation,” said TD spokesperson Crystal Jongeward.
“In a case where a claims decision is escalated to us, we will review, as we are in this case,” she said in an email.
The two cases reinforce the challenges that critical insurance policyholders can face when they need their benefits most.
“If you are told, ‘Don’t worry about anything, you’re covered,’ you should be able to trust that,” said Sivan Tumarkin, lead partner with Toronto law firm Samfiru Tumarkin LLP.
Frequently, policyholders who are denied insurance benefits accept the decision of the insurance company without a fight.
“The insurance company is expecting individuals to walk away from their rights….what kind of tactics do they use? They use a whole array of them,” said Tumarkin.
“It’s a David and Goliath situation. But who won that battle? David won that battle, and that’s what people don’t often understand,” he said.
Blackwell has other insurance to support his family while he is unable to work. He came forward, he said, to warn others who are relying on their insurance without knowing all the inherent risks.
“Make sure you’re educated about what you’re paying for,” Blackwell said, cautioning that, in his experience, critical illness insurance is “insurance that, more than likely, you’ll never collect.”
Williams has heard from TD since the story was reported but there is no change in the bank’s position yet.
“Tonight, I received a call from the claims representative who advised me the claim was still denied because my condition didn’t meet the definition that was on the policy,” Williams said.
However, she says she was told to expect another call Thursday dealing with an internal investigation into how the policy was sold to her and her husband.
She also received a personal call from her member of parliament, Erin O’Toole (Durham) who promised to call TD Bank about her case.
Blackwell’s wife, Ashley, is focused on making sure her husband’s health improves, although there is uncertainty.
“We’re very positive people so we’re always looking forward, but it’s always in the back of your head; you’re thinking about it,” she said.
Read this story via Global News.