Lawyer offers hope for Sask. family hit with massive bill after insurance claim denial

A Saskatchewan man left facing sky-high medical costs after he was denied a travel insurance claim may have legal options, according to an insurance lawyer who is offering the family help.

Recently while in Yuma, Arizona, Louis Lamothe suffered a massive stroke with his medical bills piling up to staggering amounts.

Sivan Tumarkin, who is the national co-managing partner at Samfiru and Tumarkin LLP in Calgary, Alta. said insurance companies will often look for every avenue they can to not payout a claim that was made.

“Unfortunately this is not uncommon and I say that in the context of people who are contacting me all the time asking for advice when they are denied these kinds of claims and really any insurance claim for that matter,” Tumarkin said.

Tumarkin said he is providing pro-bono assistance to Lamothe's family and is already reviewing documents related to their case.

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According to Lamothe’s granddaughter Rebecca Fee, Saskatchewan Blue Cross denied Lamothe's travel insurance claim due to a 10-milligram increase in a cholesterol medication that wasn't reported to the company.

Fee said her grandfather was very honest on his application and disclosed that he had a lung disease and that he had a heart attack in the past.

“Here’s the catch,” Tumarkin said. “It’s not about how truthful you think you are, it’s about how accurate your answers are. Most of these insurance companies don’t do any homework in the beginning, they don’t check the accuracy of these answers they simply look at these answers and then compare them to medical documents once a claim is made.”

Tumarkin said that often when an insurance company finds a discrepancy they match that up with an answer and if they can find a reason not to pay they will take it, hoping that people will not resist their decision.

In a statement provided to CTV News, Saskatchewan Blue Cross said while it couldn't get into specifics due to privacy concerns, the insurer is "confident in its handling of the Lamothe claim overall."

Blue Cross said as a non-profit insurer, its "top priority is to pay valid claims."

"Our hearts are with the family during this difficult time. We are in active contact with the Lamothe family regarding the appeals processes available to them," the statement said.

WHAT CAN YOU DO?

Tumarkin said he has three main recommendations for people to help protect themselves from a similar situation to Lamothe’s.

“When you are getting travel insurance, if at all possible do it through a broker,” he said.

According to Tumarkin, going through a broker adds an extra layer of protection, especially if the broker deals in travel insurance claims.

“They’ll be able to guide you, they are licensed and they are knowledgeable when it comes to insurance products,” he said.

Tumarkin also says people need to remember to read questions on applications very carefully.

“Don’t focus so much on answering as truthfully as you can but more so as accurately as you can. That means if you have to speak to your doctor or whoever handles your medications, make sure that the answers are as accurate as possible, don’t give the insurance company ammunition,” Tumarkin said.

The third recommendation Tumarkin has is to realize there are often legal avenues once a claim is denied.

“Insurance companies would love nothing more than people to just simply walk away and give up. Sometimes insurance companies are correct with their denials but many times they are not and so you need to make sure you get legal advice.”