Canadians often purchase disability policies from companies such as BMO Insurance to help protect them and their families in the event of illness or injury. However, making a claim can be complex and experts warn that claims may be denied if your BMO Insurance claim forms are not correct. Additionally, there are other reasons why a BMO disability insurance claim can be denied. Read on to learn more about BMO Insurance and why your claim may have been denied.

What Types of BMO Insurance Policies Are There?

BMO Insurance offers a number of policies, including two types of disability insurance: disability and disability plus job loss policies. There are a number of other policies offered through BMO, including travel and various illness insurance policies.

BMO Disability Insurance

According to BMO’s website, their disability insurance provides policyholders “financial security in the face of inability to work due to illness or injury by covering the payment on your Line of Credit.” They have policies that cover personal lines of credit, as well as student, homeowner, and small business lines.

The payout is capped between $1,500 and $3,000 a month, depending on the policy and there are limits on the amount covered, notes BMO. In addition, prospective policy holders must meet certain eligibility requirements regarding job status, age, loans, and residency.

BMO’s Disability Plus Job Loss Insurance policy is similar to their disability policies, but with an added rider to protect policyholders in the event of an “involuntary” termination.

BMO also offers life insurance products, which are different from disability insurance. The company offers both term life insurance and permanent life insurance that can help provide income to survivors in the event of the insured’s death.

How to Make A Claim?

To start a disability claim, policyholders must request BMO insurance forms, called a claim package. The BMO website notes that there is a 30-day waiting period before benefits will be paid out and claims must be made within 120 days of the disability date.

BMO insurance claim forms must include four items:

• Employer’s Statement
• Claimant’s Statement
• Attending Physician’s Statement
• A copy of the insurance application

Additionally, these forms must be completed and signed.

BMO Insurance claims are processed through Sun Life Assurance Company of Canada and must either be sent to that office or returned to the policyholder’s BMO branch in a sealed envelope to be properly filed.

On its website, BMO says that once the claim is received, claims analysts will review the medical information and other factors to determine whether to pay the claim out. This review takes place within 14 days of receipt and may include the collection of additional medical information. Policyholders should be aware that they need to continue paying premiums on the policy until their claim is approved.

Policyholders will be informed in writing about whether their claim was approved or denied.

Why Was My Claim Denied?

According to BMO’s website, there are a variety of reasons why a policyholder’s claim may be denied, including:

• Ineligibility
• Use of an unapproved health care practitioner
• Medical care is not active and continuous
• The disability was the result of one of the following events: normal pregnancy, cosmetic surgery, experimental surgery, criminal activity, self-inflicted injury or suicide attempt.

Additionally, even if a disability claim is approved, BMO will stop paying out under certain circumstances.

Experts say that there are a number of other reasons that policyholder’s BMO disability insurance claims are denied. They warn claimants to completely and correctly fill out the paperwork and be sure to submit it on time. 

Experts also say those shopping for disability insurance should read the details of the policy closely before deciding to buy and also when they make a claim. Policyholders should note that their payout may be offset by other benefits they receive, such as money from the Canada Pension Plan, workers’ compensation, auto insurance, and crime victims’ compensation.

If your insurance claim was denied, a lawyer can help you understand your policy and fight for the compensation you deserve. 

What to Do If Your BMO Insurance Claim Was Denied?

Unfortunately, many initial disability insurance claims end with a denial. According to BMO’s website, policyholders may contact Sun Life Assurance with more information if their claim is denied and they don’t agree with the reason.

In fact, Sun Life requires policyholders to engage in an extensive internal appeals process in the event of a denied claim. There are two appeals levels. In the first, claimants must provide new information for review by the original analyst and potentially an appeals team.

If the initial appeal does not result in the approval of a claim, the claim goes to a second level. At the second level, the claimant can provide additional information to the appeals team; however, if the claim remains denied, then the internal appeals process is considered complete.

The next step is a legal appeal of the disability claim denial. In a legal appeal, an adjudicator will evaluate the claim. While both the internal and legal appeals process may seem intimidating, experts say they are both common when making a disability claim.

Experts stress the importance of appealing a denial as soon as possible and considering legal representation to help ensure the claim is complete and accurate.

A lawyer can help you understand the appeals process and help you through the process. Fill out the form on this page for a free case evaluation by an insurance lawyer to increase your chances of a successful outcome.