H.L. enjoyed her work as an Administrative Assistant for six years, when she began to experience chronic pain, forgetfulness and depression. She had difficulty maintaining her regular workload. Upon visiting a physician, H.L. was diagnosed with fibromyalgia. Under the terms of her insurance policy she was entitled to benefits, which she collected for 12 months, until those benefits were suddenly and unexpectedly terminated.
Nature of the Case
H.L. worked and lived happily, was productive and gainfully employed for six years. She became disabled with fibromyalgia, depression and memory loss. For a short period of time – under a year – he insurance company paid disability benefits. Suddenly, without explanation, those benefits were terminated, even though he contract with the insurer clearly entitled her to benefits if she became totally disabled before turning sixty-five years of age.
H.L.’s insurer did not believe that she was truly disabled. With the assistance and support of Bogoroch & Associates H.L. was able to prove, then fight the insurer and claim the benefits she rightfully deserved.
Bogoroch & Associates issued a statement of claim against the insurer then proceeded to have H.L. visit a variety of medical experts to accurately diagnose her maladies. H.L. visited rheumatologists, a psychiatrist and a general practitioner so that medical documentation could be gathered to develop a larger, more complete medical scenario.
The medical reports confirmed the diagnosis of fibromyalgia. With those reports in hand, an actuarial report was developed to document lost benefits since the termination by the insurer.
The case proceeded to mediation. Richard Bogoroch dwelled on the fact that H.L. was not denied benefits during the same period, under the Canada Pension Plan, which further demonstrated bad faith on behalf of H.L.’s insurer.
The insurer discussed reinstating H.L.’s benefits, however, Richard Bogoroch argued that this act further entrenched the fact that the insurer was acting in bad faith and that a better remedy would be to provide a lump sum payment to H.L. on top of reinstating her benefits. The Bogoroch team also made it clear during the mediation that they would pursue a settlement at trial if a mediated settlement was not forthcoming.
Settlement negotiations continued and a fair and reasonable payment was agreed upon. This amount was independent of legal fees. And the insurance was reinstated to address the ongoing long-term disability.
Though H.L. was surprised and taken aback at the termination of her benefits; her life adversely affected financially – on top of suffering from ongoing illness, the Bogoroch team supported her through the process and ensured she received what was rightfully and contractually hers from her insurer. The stress of worrying about the financial outcome ended, and H.L. was able to move forward concentrating on her physical and emotional challenges.
*Please note that the settlement amounts will vary from case to case and are not reflective of what your case may be worth.