Non-disclosure. 1. The complainant s wife, Mrs P, had a policy covering death and dread
|
|
- Horatio Walker
- 5 years ago
- Views:
Transcription
1 Non-disclosure CR306 Equity - new policy issued as replacement old policy cancelled nondisclosure in application for new policy, and new policy cancelled - can claim be entertained on the replaced policy? Background 1. The complainant s wife, Mrs P, had a policy covering death and dread disease. On 30 June 2009 she made an application, on the advice of her broker, to combine her policy with that of the complainant because it would offer her a better premium rate with no loss of benefits. The replacement policy was issued on 21 July 2009, and the replaced policy was cancelled with effect from 16 July In October 2009 Mrs P was diagnosed with Motor Neuron Disease. When she instituted a claim for the payment of the benefit under the existing policy, it was repudiated on the basis that she had answered No to the following medical questions that were contained in the application form: DO YOU HAVE, OR HAVE YOU EVER HAD, TROUBLE WITH DISORDERS OR DISEASE OF (IF YES, PROVIDE DETAILS): 7. Your skin, muscles, bones, joints, limbs and spine? 8. Have you been hospitalised or had any other examinations for reasons not already mentioned including genetic testing or tumour markers, or sought medical advice for any ongoing medical problems? 9. Do you intend consulting a doctor/ medical professional in the next eight weeks, for conditions or symptoms not already disclosed, or is any future surgery planned? 3. In their response, the insurer stated as follows:..mrs P started getting pains in her left knee progressing to calf and ankle and underwent X rays and was treated with physiotherapy and Acupuncture.
2 This information has been confirmed by Mr. P in his initial letter to you. This information was not disclosed on the application dated 30 June Further, on 17 July 2009, Mrs. P underwent a series of Blood tests and the results were found to be abnormal. In terms of the application any change in Health, e.g. Blood tests prior to the acceptance of risk has to be made available to our underwriters. Based on the fact that Blood Tests had been requested, had our underwriters known, they would not have given a decision on the risk and in turn waited for the results. On seeing the results the policy would not have been issued on its current terms and further requirements would have been requested. As such our Underwriters withdrew the initial terms on issue of the contract and the contract was cancelled with effect from inception for the reasons of material non-disclosure. 4. In denying liability under the new policy the insurer therefore relied on its cancellation on the grounds of non-disclosure. 5. The insurer submitted that no claim could be entertained on the old policy either because it had been cancelled on 16 July 2009, and clause 9 stipulated: Claims procedure In order for a claim to be assessed the applicable Benefit and the Contract must be in force at the time the condition is diagnosed as well as when the claim is submitted. 6. The complainant claimed that when applying for the new policy his wife had nothing to disclose, saying that: At best, the only possible problem that Mrs P could have disclosed was a niggling knee problem which one experiences all the time and is mostly ignored by a reasonable normal person. Particularly if the lifestyle is sport related as is the case with our family. And presuming that the knee problem was disclosed, it follows that Liberty would have ordered x-rays of the knee to be done and possibly blood tests. It is a fact that the results would have been negative. Discussion 7. In view of nature of the disease with which Mrs P was diagnosed, our office referred the matter at its own expense to an independent specialist who made the following observation:
3 Mrs P had presented to Dr A in January 2009 with symptoms sufficiently impressive to warrant extensive screening tests, retrospectively shown to have been unhelpful, but later proven to be non-specific early manifestations of MND. The diagnosis was made after a second neurologist, alert to the unique and diagnostic features of MND, diagnosed the disease. Mrs P had significant motor dysfunction and discomfort during the months preceding her referral to an orthopaedic surgeon in June The independent specialist s report was forwarded to the insurer for comment, but the insurer refused to review its decision. 9. The matter was considered at a meeting of the office s adjudicators as a result of which: 9.1 The office took the view that the insurer s decision to decline the claim on the basis of material non-disclosure in respect of the new policy was justified. 9.2 In respect of the old policy, however, the office concluded that the insurer s decision to decline the claim on the basis that that policy was cancelled before Mrs P was diagnosed with a motor neuron disease was unfair. For the following reasons the meeting took the view that this was an appropriate case for the application of its equity jurisdiction: Mrs P had already had the symptoms of the motor neuron disease prior to the cancellation of the policy and there was no evidence to suggest that those symptoms had existed prior to its commencement. In support of this the meeting relied on the report of the independent specialist as set out in paragraph 6 above.
4 9.2.2 Mrs P could not have lodged her claim under the old policy prior to its cancellation. She had not been aware that she had or was developing motor neuron disease as the disease is considered to be an insidiously progressive neurological disorder which is not diagnosable for months and in any event not until clinical features unique to the disease enable a diagnosis to be made. According to the specialist s report, laboratory tests would have been unhelpful in this regard Clause 9 of the claim procedure, which requires a diagnosis to have been made while the policy is in force, presumably assumed that the average life assured would not delay in obtaining a medical diagnosis, and that such a diagnosis would be relatively easy to make. In Mrs P s case she was not to blame for any delay, and happened to have contracted a serious disease that, through no fault on her part, took time and was extremely difficult to diagnose The meeting considered it relevant to note that the new policy contained almost the same benefits that were provided in the old one, and pointed out that had Ms P not decided to replace it she would have been entitled to claim the benefits and the insurer would have been obliged to assess her claim.
5 Result 10. The unanimous view of the meeting was that a provisional determination should be made requiring the insurer to assess the claim on its merits. The insurer complied with the provisional determination and agreed to pay the benefit. NS March 2011
"Dependent Child -... a stillborn child who was inside the womb for at least 182 days."
Paul Kruger Subject: FW: Ombuzz Issue 33: April 2016 - MEDICAL OPINIONS OMBUZZ Issue Number 33 April 2016 MEDICAL OPINIONS In many complaints our office has to deal with medical evidence. At times we need
More informationLEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN
Decision Ref: 2018-0070 Sector: Product / Service: Conduct(s) complained of: Insurance Private Health Insurance Rejection of claim - pre-existing condition Outcome: Upheld LEGALLY BINDING DECISION OF THE
More informationPROFESSIONAL ATHLETES APPLICATION
Send completed application and exam to: Petersen International Underwriters 23929 Valencia Boulevard Suite 215, Valencia, CA 91355 Email: piu@piu.org Fax: (661) 254-0604 Telephone (800) 345-8816 Proposed
More informationPROFESSIONAL ATHLETES APPLICATION
Send completed application and exam to: Petersen International Underwriters 23929 Valencia Boulevard Suite 215, Valencia, CA 91355 Email: piu@piu.org Fax: (661) 254-0604 Telephone (800) 345-8816 Proposed
More informationACCIDENT AND HEALTH CLAIM FORM
ACCIDENT AND HEALTH CLAIM FORM This form is required in order to assess a potential claim under a policy of insurance. Issue and completion of this form does not in any way imply, construe or admit liability
More informationSHEDDON PHYSIOTHERAPY AND SPORTS CLINIC
Patient Name: Date of Birth: / / Last First Day Month Year Address: City: Home Tel: Other Tel: Postal Code: *E-mail: Family Physician: Do you have a Doctors referral? How did you hear about us? If so,
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [The Appellant] AICAC File No.: AC-04-080 PANEL: APPEARANCES: Mr. Mel Myers, Q.C. Chairperson Ms Laura Diamond Ms Janet Frohlich
More informationWORKERS COMPENSATION APPEAL TRIBUNAL CASE ID # [PERSONAL INFORMATION] AND: APPELLANT WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND DECISION #334
WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: [PERSONAL INFORMATION] CASE ID # [PERSONAL INFORMATION] AND: APPELLANT WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT DECISION #334 Appellant
More informationTRIBUNAL D APPEL EN MATIÈRE DE PERMIS
LICENCE APPEAL TRIBUNAL Safety, Licensing Appeals and Standards Tribunals Ontario TRIBUNAL D APPEL EN MATIÈRE DE PERMIS Tribunaux de la sécurité, des appels en matière de permis et des normes Ontario Date:
More informationSHEDDON PHYSIOTHERAPY AND SPORTS CLINIC
INTAKE FORM Patient First Name Patient Last Name Date of Birth: / / DD month YYYY Address: City: Prov: Postal Code: Mobile Tel: Home Tel: Accepts to receive SMS Text message appointment reminders *E-mail:
More informationFrequently Asked Question for i-care Rahmat
Frequently Asked Question for i-care Rahmat 1. What is this plan about? i-care Rahmat is an investment-linked plan that provides a lump sum benefit payment upon Death or Total and Permanent Disability
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [the Appellant] (formerly [text deleted]) AICAC File No.: AC-09-49 PANEL: Mr. Mel Myers, Q.C., Chairperson Dr. Patrick Doyle
More informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F SPECIALTY RISK SERVICES, RESPONDENT INSURANCE CARRIER/TPA
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F709488 EVELYN CHRONISTER BALDOR ELECTRIC COMPANY CLAIMANT RESPONDENT SPECIALTY RISK SERVICES, RESPONDENT INSURANCE CARRIER/TPA OPINION FILED
More informationA M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL
CASE NO. 18 Z 600 15061 02 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 15061 02 v.
More informationSPORTS APPLICATION FORM AND MEDICAL EXAMINER S REPORT
33 Yonge Street, Suite 270 Toronto, ON M5E 1G4 (416) 366-2223 Fax: (416) 366-4608 www.suttonspecialrisk.com SPORTS APPLICATION FORM AND MEDICAL EXAMINER S REPORT PART 1 - APPLICATION FORM. This section
More information(k) sprain means an injury to one or more tendons or ligaments, or to both; (l) strain means an injury to one or more muscles;
CERTIFIED MEDICAL EXAMINATIONS The insurance company for the party at fault in a motor vehicle accident has the right to request that an injured person submit to a Certified Medical Examination. They are
More informationCritical Illness - Statement of Medical Examiner (Stroke / Heart / End Stage Renal failure / Cancer / Others) New IC No Old IC No.
CRITICAL ILLNESS CLAIM FORM (GROUP CLAIM) SECTION A Every question must be fully answered. The Company reserves the right to require further information should it deem necessary. Submission of this Claim
More informationCASE ID # [PERSONAL INFORMATION] APPELLANT AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND DECISION #291. Nicole McKenna, Worker Advisor
WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: [PERSONAL INFORMATION] CASE ID # [PERSONAL INFORMATION] APPELLANT AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT DECISION #291 Appellant
More informationCRISIS COVER CLAIM FORM (MOTOR NEURONE DISEASE)
C010616 PruCustomer Line: 1800-333 0 333 CRISIS COVER CLAIM FORM (MOTOR NEURONE DISEASE) SECTION 1 This section is to be completed by the Life Assured who is at least 18 years old or the policyowner if
More informationLong term care insurance Attending physician s statement
Long term care insurance Attending physician s statement PLEASE PRINT 1 Personal information Sections 1 and 2 are to be completed by the patient (insured person) Please complete the first page and then
More informationPatient Registration Form
Patient Registration Form Patient Information Account # : Address: Primary Phone: Please indicate the best number for your appointment reminder calls: Home Cell Text Alternate Phone: Email: May we contact
More informationGC12 Limited Benefit Group Cancer Indemnity Insurance Region VIII TIPS EBC Group #13041
GC12 Limited Benefit Group Cancer Indemnity Insurance Region VIII TIPS EBC Group #13041 THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER
More informationCancer. About this Benefit AMERICAN PUBLIC LIFE YOUR BENEFITS DID YOU KNOW?
AMERICAN PUBLIC LIFE Cancer YOUR BENEFITS About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with
More informationIncome Protector Optional Rider benefits
For intermediaries Sanlam Risk Cover January 2015 Income Protector Optional Rider benefits Primary Income Protector benefits Waiting period Sickness Temporary Disability Income Including fixed payment
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [the Appellant] AICAC File No.: AC-10-148 PANEL: APPEARANCES: Mr. Mel Myers, Q.C. The Appellant, [text deleted], appeared
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1158/16
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1158/16 BEFORE: R. Nairn: Vice-Chair HEARING: April 20, 2016 at Toronto Written DATE OF DECISION: July 22, 2016 NEUTRAL CITATION: 2016 ONWSIAT
More informationIN THE PENSION APPEALS BOARD IN RE THE CANADA PENSION PLAN JOYCE HEADLAM. - and- THE MINISTER OF EMPLOYMENT AND IMMIGRATION.
IN THE PENSION APPEALS BOARD IN RE THE CANADA PENSION PLAN BETWEEN: JOYCE HEADLAM Appellant - and- THE MINISTER OF EMPLOYMENT AND IMMIGRATION Respondent Appeal CP 3506 heard in Toronto, Ontario May 10,
More informationAIA SINGAPORE PERSONAL LINES CLAIM FORM
AIA SINGAPORE PERSONAL LINES CLAIM FORM Policy No : Name of Insured : Contact No : Circumstances of Loss / Damage / Injury / Accident (Date of Claim / Where it Happened? / How it Happened?) *Please provide
More informationJoseph A. Khawly, MD FACS Eric R. Holz, MD FACS Arthur W. Willis, MD FACS Hassan T. Rahman, MD FACS Emmanuel Y. Chang, MD PhD FACS Jonathan H.
Joseph A. Khawly, MD FACS PATIENT INFORMATION Patient s name (first and last): Marital Status: Is this your legal name? If not, what is your legal name? Former name: Birth Date: Age: Gender: YES NO M F
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [the Appellant] AICAC File No.: AC-05-217 PANEL: APPEARANCES: Ms Yvonne Tavares, Chairperson Ms Diane Beresford Mr. Robert
More informationPATIENT REGISTRATION FORM
Today s Date: PATIENT REGISTRATION FORM PATIENT INFORMATION Last Name: First: Mi. Init: DOB: Age: SSN: Gen: M F Marital Status: S M D W Race: African American American Indian Asian Caucasian Hispanic Pacific
More informationName of Insured/Covered Member: NRIC/Passport No./ Fin No.: Contact No.:
AIA SINGAPORE PERSONAL LINES CLAIM FORM Important Notes: 1) This printed form is forwarded on receipt of notice of a claim and its being sent is in no way an admission of claims. 2) Please ensure that
More informationWORKERS COMPENSATION APPEAL TRIBUNAL [PERSONAL INFORMATION] CASE ID # [PERSONAL INFORMATION]
WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: [PERSONAL INFORMATION] CASE ID # [PERSONAL INFORMATION] APPELLANT AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT DECISION #335 Appellant
More informationGROUP INSURANCE EVIDENCE OF INSURABILITY FORM. SECTION 1: EMPLOYER INFORMATION (to be completed by authorized Plan Administrator):
GROUP INSURANCE EVIDENCE OF INSURABILITY FORM RBC Life Insurance Company 6880 Financial Drive, Tower 1, Eighth Floor Mississauga, Ontario L5N 7Y5 Please answer all applicable questions; all subsequent
More informationEarly Payment of Life Protection
Early Payment of Life Protection Claim Form Pages 1 3 to be completed by the insured person and pages 5 6 to be completed by the treating doctor. We ll assess your claim as quickly as possible. The information
More informationPROFESSIONAL ATHLETES APPLICATION
SHORT FORM Name in Full: FI RST Residence Address: MIDDLE LAST STREET AND NUMBER CITY Personal information: Occupation Details: STATE DATE OF BIRTH ( ZIP HEIGHT DAYTIME PHONE NUMBER WEIGHT SPORT LEAGUE
More informationPATIENT REGISTRATION FORM
Today s PATIENT REGISTRATION FORM PATIENT INFORMATION Last Name: First: Mi. Init: DOB: Age: SSN: Gen: M F Marital Status: S M D W Race: African American American Indian Asian Caucasian Hispanic Pacific
More informationBEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F NANCY LOPER, EMPLOYEE JOE PAULK COMPANY, EMPLOYER OPINION FILED MARCH 21, 2007
BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F400982 NANCY LOPER, EMPLOYEE JOE PAULK COMPANY, EMPLOYER STATE AUTOMOBILE MUTUAL INSURANCE CO., CARRIER CLAIMANT RESPONDENT RESPONDENT OPINION
More informationPatient Health Information Consent Form
Patient Health Information Consent Form We want you to know your Patient Health Information (PHI) is going to be used in this office as well as your rights concerning those records. Before we will begin
More informationMEDISECURE CENTURIAL POLICY (Hospitalisation and Surgical Insurance)
MEDISECURE CENTURIAL POLICY (Hospitalisation and Surgical Insurance) FOR CONSUMER INSURANCE CONTRACTS (INSURANCE WHOLLY FOR PURPOSES UNRELATED TO YOUR TRADE, BUSINESS OR PROFESSION) This Policy is issued
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1220/12
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1220/12 BEFORE: G. Dee : Vice-Chair M.P. Trudeau : Member Representative of Employers R.W. Briggs : Member Representative of Workers HEARING:
More informationKEY FEATURES OF CRITICAL ILLNESS COVER PROTECTION FOR LIFE. Important information you need to read
KEY FEATURES OF CRITICAL ILLNESS COVER PROTECTION FOR LIFE Important information you need to read THE FINANCIAL CONDUCT AUTHORITY IS A FINANCIAL SERVICES REGULATOR. IT REQUIRES US, SCOTTISH WIDOWS, TO
More informationOmbudsman s Determination
Ombudsman s Determination Applicant Scheme Respondents Mrs R Local Government Pension Scheme (LGPS) Essex County Council (ECC) Hedingham School and Sixth Form (Hedingham School) Outcome 1. Mrs R s complaint
More information2 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 823/02
2 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 823/02 DECIDED BY B. L. Cook : Vice-Chair W.D. Jago : Member Representative of Employers P.B. Hodgkiss : Member Representative of Workers
More informationTHE NEW INDIA ASSURANCE CO. LTD. MEDICLAIM 2012 POLICY- PROSPECTUS
THE NEW INDIA ASSURANCE CO. LTD. REGISTERED & HEAD OFFICE: 87, MAHATMA GANDHI ROAD, MUMBAI 400001 MEDICLAIM 2012 POLICY- PROSPECTUS We welcome you as Our Customer. This document explains how the MEDICLAIM
More informationSummary of Benefits and Insurance Offerings
Summary of Benefits and Insurance Offerings Effective March 1, 2018 December 31, 2018 Table of Contents Health Plan - Examples and Explanations... 2 Healthcare Plan Offerings... 6 Dental Plan Offerings...
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1854/06
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1854/06 BEFORE: L. Gehrke: Vice-Chair HEARING: September 19, 2006 at Toronto Written DATE OF DECISION: September 27, 2006 NEUTRAL CITATION:
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [The Appellant] AICAC File No.: AC-05-019 PANEL: APPEARANCES: Ms Yvonne Tavares, Chairperson Ms Janet R. Frohlich Mr. Paul
More informationYour life, your freedom
Health Your life, your freedom GLOBALCARE HEALTH PLAN A comprehensive international health insurance plan that offers optimal worldwide coverage for your medical needs. Whether you live in Singapore or
More information2017 REEP/ HSA Plan with Chiropractic. Benefit Summary. Family Coverage Each Member in a Family of two or more Members
Benefit Summary 2017 REEP/ HSA Plan with Chiropractic Principal Benefits for Kaiser Permanente HSA-Qualified Deductible HMO Plan (7/1/17 6/30/18) "Kaiser Permanente HSA-Qualified Deductible HMO Plan" is
More informationKRAIG R. PEPPER, D.O. P.A.
Thank you for choosing Dr. Kraig Pepper, D.O. P.A. for your care. The following is required to provide you with the quality medical care. The doctor and staff will review this information and place it
More informationEugene Eye Clinic, LLC
John D. Polansky, M.D. & Jason P. Gross, M.D. 2460 Willamette Street, Eugene, OR 97405 Phone (541) 683-3744 Fax (541) 683-6672 www.eugeneeyedoctors.com Welcome to the Eugene Eye Clinic is scheduled for
More informationLife Insurance Application Part B
Life Insurance Application Part B American General Life Insurance Company, Houston, TX The United States Life Insurance Company in the City of New York, New York, NY AIG Life Insurance Company, Wilmington,
More informationCRITICAL ILLNESS INSURANCE. Transition. Made for you!
CRITICAL ILLNESS INSURANCE Transition Made for you! Critical illness insurance first originated in South Africa in the early 1980s. It was designed by a renowned heart surgeon, Marius Barnard, who based
More informationPatients who are running 20 minutes late for his/her scheduled appointment will be rescheduled to the next available appointment/ day.
Orthotics/ Durable Medical Equipment Policy H2T is NEVER able to guarantee payment by medical insurance carriers for Orthotics and/or Durable Medical Equipment. H2T will bill your medical insurance as
More informationCritical Illness Insurance. Second Chance for Children 30 days to 17 years
Critical Illness Insurance Second Chance for Children 30 days to 17 years Second Chance for Children Protect your children in case of critical illness so you can afford to stay by their bedside If one
More informationPersonal accident claim form
The issue of this claim form does not imply an admission of liability by us. Only a fully completed and signed claim form can receive our further assessment and consideration. Index Sections 1, 2, 9 and
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [the Appellant] AICAC File No.: AC-10-53 PANEL: APPEARANCES: Ms Yvonne Tavares, Chairperson Ms Leona Barrett Ms Linda Newton
More informationCRITICAL ILLNESS Motor Neuron Disease
CRITICAL ILLNESS Motor Neuron Disease Labourers Union Local 506 (Industrial Division) Employee Benefit Trust Fund Policy No.: CI9426177 Labourers' Union Local 506 (Industrial Division) Employee Benefit
More information$1,000,000 EXCESS MAJOR MEDICAL COVERAGE
$1,000,000 EXCESS MAJOR MEDICAL COVERAGE AN Excess Major Medical Plan Used To Layer Over Existing Medical Coverage AVAILABLE WITH Optional Sickness Coverage PROPOSAL FOR: PETERSEN INTERNATIONAL UNDERWRITERS
More informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F OPINION FILED DECEMBER 30, 2005
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F502651 JEFFREY CALLAHAN QUICK LAY PIPE COMPANY COMMERCE & INDUSTRY INSURANCE CARRIER CLAIMANT RESPONDENT RESPONDENT OPINION FILED DECEMBER
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 967/14
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 967/14 BEFORE: R. Nairn: Vice-Chair HEARING: May 12, 2014 at Toronto Written DATE OF DECISION: August 29, 2014 NEUTRAL CITATION: 2014 ONWSIAT
More informationA M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL
CASE NO. 18 Z 600 17093 02 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 17093 02 v.
More informationBEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F OPINION FILED AUGUST 9, 2004
BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F001912 PAMELA KILPATRICK, EMPLOYEE SUCCESS STAFFING CORP., EMPLOYER ONE BEACON INSURANCE CO., INSURANCE CARRIER CLAIMANT RESPONDENT RESPONDENT
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 760/15
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 760/15 BEFORE: S. Ryan: Vice-Chair HEARING: April 17, 2015 at Toronto Written DATE OF DECISION: April 24, 2015 NEUTRAL CITATION: 2015 ONWSIAT
More informationBridging The Gap To. Medicare Eligibility FOR. U.S. Citizens Or U.S. Residents Awaiting. Medicare Eligibility
Bridging The Gap To Medicare Eligibility FOR U.S. Citizens Or U.S. Residents Awaiting Medicare Eligibility OR U.S. Citizens Or U.S. Residents Without Medicare Part A Or Part B Petersen International Underwriters
More informationLesson 3: Failing to Get Medical. Treatment the Right Way
Lesson 3: Failing to Get Medical Treatment the Right Way Rule: The insurance company picks the medical provider. The injured worker can request a change in treatment. When you need a doctor, of course
More informationA M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL
CASE NO. 18 Z 600 12025 03 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 12025 03 v.
More informationApplication for Alumni Insurance
Application for Alumni Insurance Especially for: Underwritten by: Insurance Plan Choices (Do not include insurance already in force.) New Client Existing Client Certificate # (if currently insured) Monthly
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 137/15
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 137/15 BEFORE: K. Jepson : Vice-Chair M. Christie : Member Representative of Employers F. Jackson : Member Representative of Workers HEARING:
More informationAsgard Employer Super: Life insurance Application
Asgard Employer Super: Life insurance Application BT Funds Management Limited ABN 63 002 916 458 AFSL 233724 holds the Master Policies of insurance issued by Westpac Life Insurance Services Limited ABN
More informationThank you for downloading this information.
Thank you for downloading this information. For more information, advice or for a free quote, please contact our global head office at the address below who will redirect you to a regional office located
More informationGroup Hospital and Surgical Claim Form
NTUC Income Insurance Co-operative Limited Income Centre 75 Bras Basah Road Singapore 189557 Tel: 6332 1133 Fax: 6338 1500 Email: healthcare@income.com.sg Website: www.income.com.sg Group Hospital and
More informationA M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL
CASE NO.18 Z 600 02899 02 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 2899 02 v. INS.
More informationNoteworthy Decision Summary. Decision: WCAT RB Panel: Randy Lane Decision Date: November 25, 2003
Noteworthy Decision Summary Decision: WCAT 2003-03729-RB Panel: Randy Lane Decision Date: November 25, 2003 Causation Causative significance - Whether employment was of causative significance with regard
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 242/15
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 242/15 BEFORE: S. Netten: Vice-Chair HEARING: February 2, 2015 at Toronto Written DATE OF DECISION: February 20, 2015 NEUTRAL CITATION: 2015
More informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F TYSON POULTRY, INC., SELF INSURED OPINION FILED NOVEMBER 4, 2008
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F802738 CHRYSTAL STEDMAN TYSON POULTRY, INC., SELF INSURED TYNET CORPORATION, TPA CLAIMANT RESPONDENT RESPONDENT OPINION FILED NOVEMBER 4,
More informationLIFESTYLE PROTECTOR LIVING LIFESTYLE
LIVING LIFESTYLE Top five reasons to have Living Lifestyle 1 Living Lifestyle is a market-leading benefit on the Lifestyle Protector product It provides comprehensive coverage and financial security for
More information2. Details of the Claimant if different than the Life Assured (To be filled by person entitled to receive claim proceeds under the policy):
CLAIM INTIMATION - CUM - CLAIMANT S STATEMENT (CRITICAL ILLNESS RIDER / MAJOR SURGERY ASSISTANCE RIDER ) (Format : AP) Guidelines/ Notes: 1. The benefit is payable subject to the policy being inforce on
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1543/08
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1543/08 BEFORE: J. Parmar : Vice-Chair J. Seguin : Member Representative of Employers R. J. Lebert : Member Representative of Workers HEARING:
More informationPRIVILEGES AND CONDITIONS
PRIVILEGES AND CONDITIONS 1. Benefits We shall pay the benefits as specified in the schedule if a member incurs medical expenses due to illness or injury for primary care, specialist care or hospital care
More informationHIGHLIGHTS OF THE NEW PERSONAL INJURY PROTECTION ( PIP ) STATUTE SIGNED INTO LAW ON MAY 04, 2012
HIGHLIGHTS OF THE NEW PERSONAL INJURY PROTECTION ( PIP ) STATUTE SIGNED INTO LAW ON MAY 04, 2012 By Travis L. Stock, Esq. May 14, 2012 On May 04, 2012, Governor Rick Scott signed legislation that purportedly
More informationIntegrated Spinal Solutions Patient Information
Integrated Spinal Solutions Patient Information Patient Name: City/State/Zip: Today s Date: Home Telephone: Work Telephone: Birth Date: Age: Cellular Telephone: Height: Weight: Employer s Name: Social
More informationMotor Vehicle Collision Summary Advice Form
Motor Vehicle Collision Summary Advice Form Form 1.03 TO: (Name) (Address) FROM: KUBITZ & COMPANY Lawyers 1716 10 th Avenue S.W. Calgary, Alberta T3C 0J8 (City, Province, Postal Code) Home and Work Phone
More informationKruse Park Chiropractic Clinic
Kruse Park Chiropractic Clinic 3990 Collins Way, Suite 201 Lake Oswego, OR 97035 Phone: 503-635-1236 Fax: 503-697-4741 Web: www.kruseparkchiro.com Today s Date: Name NEW PATIENT REGISTRATION How did you
More informationEnsuring Your Pet s Health. A Guide for Pet Owners from the American Animal Hospital Association
Ensuring Your Pet s Health A Guide for Pet Owners from the American Animal Hospital Association 1 Dear Fellow Pet Owner, Opening your home to a pet is one of the most rewarding experiences you will ever
More informationAdjust or not to adjust an entire transaction?
Adjust or not to adjust an entire transaction? Adjustments reduce the ability to collect Adjustments reduce your profit Adjustments can create a loss Consequently, before keying an adjustment, we should
More informationLife Insurance Application Part B Connecticut Version
American General Life Insurance Company, Houston, TX The United States Life Insurance Company in the City of New York, New York, NY AIG Life Insurance Company, Wilmington, DE Subsidiaries of American International
More informationSummary of Insurance and Benefits Offerings Effective March 1, 2017 February 28, 2018
Summary of Insurance and Benefits Offerings Effective March 1, 2017 February 28, 2018 Table of Contents Health Plan - Examples and Explanations... 2 Healthcare Plan Offerings... 6 Dental Plan Offerings...
More informationAutomobile Injury Compensation Appeal Commission
Automobile Injury Compensation Appeal Commission IN THE MATTER OF an Appeal by [the Appellant] AICAC File No.: AC-01-79 PANEL: APPEARANCES: Mr. Mel Myers, Chairperson Ms Carole Wylie Ms Sandra Oakley The
More informationCLUB SUPER PERSONAL ACCIDENT AND SICKNESS CLAIM FORM
1 of 7 CLUB SUPER PERSONAL ACCIDENT AND SICKNESS CLAIM FORM This claim form consists of 3 parts and all sections must be completed in full. Section A Claimant Statement The claimant is to complete all
More informationPersonal mobility guard insurance claim form
Personal mobility guard insurance claim form Important notice If we accept this form, this does not mean we are taking legal responsibility for your claim. If we ask for any documents as proof or a report,
More informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F JAMES DAVID LONGLEY CITY OF FAYETTEVILLE, SELF INSURED
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F811732 JAMES DAVID LONGLEY CITY OF FAYETTEVILLE, SELF INSURED CLAIMANT RESPONDENT MUNICIPAL LEAGUE WC TRUST, RESPONDENT INSURANCE CARRIER/TPA
More informationPrairie Life Chiropractic 1224 S. Main Ave. Sioux Center, IA 51250
Patient Information Name Birth Date Guardian s Name (If applicable) Address City State Zip Home Phone ( ) Cell ( ) Email Sex: Age SS# Race: Ethnicity: Occupation Employer Employer City Employer Phone(
More informationMANAGED HEALTHCARE SYSTEM (MHS) OUTPATIENT PLAN PRIVILEGES AND CONDITIONS
MANAGED HEALTHCARE SYSTEM (MHS) OUTPATIENT PLAN PRIVILEGES AND CONDITIONS 1. Benefits We shall pay the following benefits as specified in the schedule if incurred by the member for any outpatient medical
More informationAssociation of British Insurers
Association of British Insurers Statement of Best Practice for Sales of Individual and Group Private Medical Insurance November 2017 Introduction This Statement of Best Practice ( the Statement ) applies
More informationDisability claim Attending physician s statement of disability
To avoid any delays in the assessment of this claim, the Claimant s statement and the Employer s statement must be submitted. Any cost for information to support your claim will be the policy owner s responsibility.
More informationLife Cover: Amendment form
Universities Money Purchase AVC (MPAVC) Facility Life Cover: Amendment form Please use black ink and write in CAPITAL LETTERS or tick as appropriate. Any corrections must be initialled. Please do not use
More informationTake It Easy Managed Care Programme
Take It Easy Managed Care Programme Product Disclosure Sheet (Read this Product Disclosure Sheet before you decide to take out the Take It Easy Managed Care Programme. Be sure to also read the general
More informationABI Statement of Best Practice for CI +
ABI Statement of Best Practice for CI + ILAG 29/04/2014 Phil Cleverley 1 Agenda Team and timetable for the Statement of Best Practice (SoBP) for Critical Illness 2014 Principles and objectives of the SoBP
More information