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As you are probably aware, insurance companies are in the business of making money, and some of them will stop at nothing to limit or eliminate the services they must pay their policyholders in accordance with the terms of their contracts. In fact, over the past decade, insurance companies have increasingly refused to provide services to their policyholders, in an effort to dissuade them from using their coverage and thus increase their profits.
As an insurance company is governed by insurance Act, it is expected to respect the terms of its policyholders’ contracts.
Since group insurance contracts are made up of three distinct parties: the employer, the insured and the insurance company, should your insurance company deny payment for the services you were provided by a member of a respective professional association within the scope of your insurance coverage, this matter is of no concern to the service provider, as only the parties to the insurance contract are legally entitled to take action in this matter.
For the reasons outlined above, should your insurance company refuse to reimburse your claim and refuse to honor the terms of your contract, regardless of the reason given by your insurance company, you, as a party to the insurance contract, have the right to contest this dispute before the Small Claims Court.
Lastly, since most insurers do not wish to be sued whenever their position is not legitimate and their arguments are not convincing, it is highly likely that shortly after receiving your formal notice, your insurance company will quickly process your claim and you will not have to go to court.
CPMDQ v. SSQ Superior court judgement