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How can they legally refuse benefits?

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M

mustang

Guest
as my previous posts mentioned i was in an auto accident in 98. i am 5 months post op from fusion surgery. i submitted expenses for housekeeping and homemantainence and caregiveing as these are the titles of benefits for a homemaker here in canada. they cut off benefits in oct 98 saying that my condition was pre-existing d.d.d. my ins. co sent me to see a defence doc in feb 2000 just before my surgery. his report was a joke. anyway...my surgeon did his legal report jan.18,2000 and said in no uncertain terms that my condition is 100% from the accident.[yes finally someone to substanciate what i have been saying] with this, i did submit all my expenses from the time they cut me off until may 2000. i just received a letter from the ins. co that they refused my benefits as the medical documentation does not support these expences? can they be serious? i had such respect for doctors and i thought the ins. co had to abide by laws....this is not a case of fraud so why the shotty treatment? i am at such a loss as to what to do..i thought all i had to provide is causation to get my benefits...??? i feel like i am in a corner with nowhere to turn. can they legally do this? and what recourse do i have? as it is, my surgeon imposed restrictions that i am left unable to do ANY house work. i was going to hire an occupational therapist to come into my home to show me how to do things as i have lost mobility due to the surgery, and when i told her my restrictions, they said they could not help me at this time as i can not do anything. so what is with this ins. co doing this to me? i do not feel like a human being anymore......help!
 


P

prairielaw3

Guest
I cannot speak for Canadian law, but generally ( especially if they a doc's report in thier hip pocket from their IME doc, insurance co's can do most anything. They can say they a right to believe their doc over your doc. I hope you have an attorney--if not, get one asap; you cannot assume an insurance co will act in your interests. Delay can olny jeopardize your rights. If you have a good and experienced attorney, let him/her handle it and hope a jury sees through the fiction.
Good luck!

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George H. Senteney
http://www.prairielaw.com
 

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