QUESTIONNAIRE FROM SSQ AND OTHER INSURERS

COUR SUPÉRIEURE JUGEMENT CPMDQ c. SSQ

CONTRACT NOT FULFILLED: REMEDY OPTION

When SSQ refuses to reimburse a claim on the grounds that the professional association or its Members do not meet the insurer’s standards and criteria, in the absence of regulations governing the practice of alternative medicine by the Quebec legislator, the reason for the insurer’s refusal to reimburse is without legal basis.

In the fall of 2013, for the first time since 1991, SSQ conducted an evaluation of the recognition standards for service providers who are members of the various alternative medicine associations in Quebec. However, even before completing its assessment, SSQ suddenly removed members of some 80 professional associations from its list of providers, believing that, in the absence of regulation of the various alternative medicine approaches, these service providers lacked competence and did not meet SSQ’s standards and criteria.

As part of its 2013 assessment, SSQ asked the associations for their membership lists, including addresses, telephone numbers and other information on some 80 professional associations, with a view to assessing the academic qualifications of each service provider who was a member of these 80 professional associations. However, the CPMDQ, anxious to protect and respect the confidentiality of the information collected from its members, rightly opposed SSQ’s request by appealing to the Superior Court.

Although the court’s decision was favourable to the CPMDQ’s interests, as evidenced by the testimony of an SSQ insured we received by e-mail, it is likely that SSQ persists in occasionally disadvantaging some of its insureds by refusing to reimburse them for services they would have received as they are entitled to under the insurance contract.