3 Posts
Hi there, My name is vince my mom was diagnosed with breast cancer 10 years ago, stage 2 she was treated with chemo and radiation and was at the time considered cured. During this process she applied for disability insurance with her bank for her mortgage and secured line of credit, she was approved which helped cover all the payments until she got better and went to work. Unfortunetly 10 years later she has been re-diagnosed with breast cancer again but this time spread to bones, we reapplied for benefits again with her bank only to be denied because even though she doesn't have breast cancer on her breast she does have a type of breast cancer and therefore from what i understand all insurance companies have a clause saying they won't pay for same disability twice. This basicly means that any women who suffers from breast cancer more than once will be declined.
our family was lucky that our mortgage was managable, i can't imagine other families who receive devastating news that their loved one is fighting the battle of their life and then know that they won't receive any mtg insurance (which we have been paying all these years in between diagnosis)
My advice to everyone who has ever had breast cancer and taken mtg disability, reach out to your bank or insurance companies and ask. I don't wish on any women to have to go through breast cancer once let alone twice, but unfortunetly some do, and i think it's important that everything is set up so that the last thing on your mind should be if you will able to pay bills to have a roof over your heads. I wish you all luck and a speady recovery, hope this is helpful to anyone.
our family was lucky that our mortgage was managable, i can't imagine other families who receive devastating news that their loved one is fighting the battle of their life and then know that they won't receive any mtg insurance (which we have been paying all these years in between diagnosis)
My advice to everyone who has ever had breast cancer and taken mtg disability, reach out to your bank or insurance companies and ask. I don't wish on any women to have to go through breast cancer once let alone twice, but unfortunetly some do, and i think it's important that everything is set up so that the last thing on your mind should be if you will able to pay bills to have a roof over your heads. I wish you all luck and a speady recovery, hope this is helpful to anyone.
7 Replies
2491 Posts
Thank you for this information vkit . I am sure it will be helpful to others. I am sorry your mom didn't have this information when it was needed.
How is your mom doing? Is she in treatment now?
Lianne
How is your mom doing? Is she in treatment now?
Lianne
40 Posts
Hi vkit,
My suggestion to you, if you haven’t already done so, is to review all the documentation that you have relating to the mortgage disability coverage when it was initially obtained. It may not have shown that specific exclusion years ago. If so, then you likely have no recourse, but if it is ambiguous, you may have a case to appeal the decision to the insurer. If that is also declined, then I suggest that you have it reviewed by a lawyer who specializes in that area. Your provincial Law Society may have a program where you can get a free 30 minute appointment with a lawyer in the area of law you need. In that time they should be able to give you an idea of whether you have the basis for a potential action against the insurer, or other options you may have. Sometimes just the threat of a legal action will get the insurer to reconsider.
Good luck!
Babs
My suggestion to you, if you haven’t already done so, is to review all the documentation that you have relating to the mortgage disability coverage when it was initially obtained. It may not have shown that specific exclusion years ago. If so, then you likely have no recourse, but if it is ambiguous, you may have a case to appeal the decision to the insurer. If that is also declined, then I suggest that you have it reviewed by a lawyer who specializes in that area. Your provincial Law Society may have a program where you can get a free 30 minute appointment with a lawyer in the area of law you need. In that time they should be able to give you an idea of whether you have the basis for a potential action against the insurer, or other options you may have. Sometimes just the threat of a legal action will get the insurer to reconsider.
Good luck!
Babs
1637 Posts
vkit Babs1 has written words of wisdom. I am sure that the new cancer diagnosis is excluded as there is a pre-existing condition exclusion. This should have been clearly explained by the salesperson at the time. It is something that most of us need to be aware of whenever we purchase an insurance policy relating to our health. Consulting a lawyer will help understand the coverage and reason for the denial of the claim.
40 Posts
vkit and Wendy Tea,
For the insurer to have paid the initial claim, I expect that she would have had the coverage in place prior to the first diagnosis, so not a preexisting condition when initially obtained & if that is the same policy in place now, also not preexisting. If I understand correctly, she didn’t apply for the initial coverage after she was diagnosed, but made a claim under it at that time. Vkit indicated the most recent claim was denied as “they won’t pay for same disability twice”. It sounds like she has an old policy, and insurance companies are constantly adding new exclusion clauses, which is why the documentation she has should be reviewed to see if that clause is there. If they can’t find it, they should request copies of the signed documents from their mortgage holder or the insurer. Should also bear in mind that there is a 2 year statute of limitations in most provinces, to initiate an action, so shouldn’t wait too long to check into it.
Babs
For the insurer to have paid the initial claim, I expect that she would have had the coverage in place prior to the first diagnosis, so not a preexisting condition when initially obtained & if that is the same policy in place now, also not preexisting. If I understand correctly, she didn’t apply for the initial coverage after she was diagnosed, but made a claim under it at that time. Vkit indicated the most recent claim was denied as “they won’t pay for same disability twice”. It sounds like she has an old policy, and insurance companies are constantly adding new exclusion clauses, which is why the documentation she has should be reviewed to see if that clause is there. If they can’t find it, they should request copies of the signed documents from their mortgage holder or the insurer. Should also bear in mind that there is a 2 year statute of limitations in most provinces, to initiate an action, so shouldn’t wait too long to check into it.
Babs
3 Posts
Hi ladies, thank you for your input, so just to make things clear as it might help some of you and others going forward. My mom was already paid once disability during her first time with breast cancer, there was no issues at all with the approval. she remained with the same bank/insurance company as we didn't move houses. 10 years later she has a relapse and then applies and is declined becuase "under the terms of your policy with Bank, if your disability develops into another related condition so that you are disbaled from new disability that is the direct or inderect result of the intial disability, this will be considered as one period of disability and the max period (depends on each bank check to see if it's 12, 24 or more months) This is known as a conccurrent disability"
so basically if you suffer from breast cancer and need to have operation and chemo and radiation and treatment lasts lets say 6 months or maybe more
then if you happen to suffer depression because of you breast cancer this is now a new disability however it counts under your old disability claim, so lets say this is another 6 months
let's say you are approved for both, you have now may have used the maximum allowed time per disablity (not sure what it is for each company) that means if you get cancer on your bones and they consider it to be the same type as your previous cancer, than again new disability but still falls under the old claim limit.
The way I interpret it, if you have had cancer once and you have had to use your disability for one year or more, than you need to plan for that. I am not blaming the insurance company, i am however shocked that there isn't some kind of special clause for cancer specifically. I hope that clears up any confusion, like i said we were lucky that the payments were managable, however I can't imagine other women receving devasting news their cancer has returned then having to worry how they will pay their mortgage
also please call and ask, or get something in writing, people that sell these products are not always aware of all these little clauses, so i just really encourage everyone to do reasearch on their policy, i think it's worth the time on the phone you have to put in
my mom is doing ok, she is on treatment and will most likely have to be on some kind of meds always, however I am thankful to God that she is one of the lucky ones.
hope this helps take care ladies
so basically if you suffer from breast cancer and need to have operation and chemo and radiation and treatment lasts lets say 6 months or maybe more
then if you happen to suffer depression because of you breast cancer this is now a new disability however it counts under your old disability claim, so lets say this is another 6 months
let's say you are approved for both, you have now may have used the maximum allowed time per disablity (not sure what it is for each company) that means if you get cancer on your bones and they consider it to be the same type as your previous cancer, than again new disability but still falls under the old claim limit.
The way I interpret it, if you have had cancer once and you have had to use your disability for one year or more, than you need to plan for that. I am not blaming the insurance company, i am however shocked that there isn't some kind of special clause for cancer specifically. I hope that clears up any confusion, like i said we were lucky that the payments were managable, however I can't imagine other women receving devasting news their cancer has returned then having to worry how they will pay their mortgage
also please call and ask, or get something in writing, people that sell these products are not always aware of all these little clauses, so i just really encourage everyone to do reasearch on their policy, i think it's worth the time on the phone you have to put in
my mom is doing ok, she is on treatment and will most likely have to be on some kind of meds always, however I am thankful to God that she is one of the lucky ones.
hope this helps take care ladies
1637 Posts
Babs1 and vkit This is an extremely complex issue and likely every case has it's own nuances. For instance after the first disability claim, when the claim has been finalized then the claimant signs a final release. This forever closes the claim. Any further illness or injury would be considered a new claim. A new claim for the same condition would be excluded under a pre-existing condition exclusion.
This is my best guess as to what has happened. The insurance company should be able to explain. Or a lawyer.
This is my best guess as to what has happened. The insurance company should be able to explain. Or a lawyer.