Broker goes out of its way for denied claimant

by Will Ashworth18 Dec 2015
Vancouver Island resident Katie Muller was badly hurt in November 2014 when she fell off her horse breaking her neck as well as the use of her hands and legs in the process.
 
Fortunately, or so she thought, Mueller had bought a $30,000 insurance policy from the Horse Council of BC and underwritten by SSQ Financial Group that protected people in her shoes that had suffered “a permanent and catastrophic injury.”
 
SSQ rejected the claim despite the fact the young mother was forced to relearn how to walk.
“SSQ Financial Group said the injury did not meet the policy’s qualifications because it wasn’t a permanent total disability,” said Mueller in a statement.

Mueller posted on Facebook in November about her trials and tribulations since the accident; it’s not a great story to tell but fortunately there’s a silver lining.

Capri Insurance is broker based in Kelowna, B.C., which provides provincial equine associations with group insurance coverage for their members. In its capacity of broker it had nothing to do with the claim’s denial.

Nonetheless, Capri felt so badly for Mueller that they stepped up and made things a whole lot better for the former equestrian.  

“Although Capri Insurance is a broker, and not the insurance company who denied my claim, they have contributed $30,000 to help cover my ongoing expenses,” Mueller said in a statement.

Mueller has appealed SSQs rejection of her claim and if the insurance company sees fit to do the right thing she could be in line for $60,000 rather than the originally contracted amount.

Muller said experts at Capri Insurance are also helping her with her appeal and asking her for feedback so they can “better service Horse Council of BC members who are dealing with losses like mine.”

At this time of year it’s nice to hear some in the insurance industry are looking out for others and not just the bottom line.

Kudos to Capri Insurance for a job well done.

COMMENTS

  • by Mark M 2015-12-18 12:23:07 PM

    Thanks for the nice story about Capri trying to do the right thing for their client.

    Thanks for the warning about SSQ NFG who do not pay claims. It is a good reminder that the premium should not be the only factor in choosing an insurance company. SSQ's refusal to pay such a claim reflects badly on them and our industry as a whole.

    Good luck to Capri!



  • by bruce 2015-12-18 12:37:35 PM

    Was the disability total and permanent or not? Seems not, there are policies to cover accidents where the disability is not total and permanent, just not this one, so shame on the broker who sold this to the Association. Very difficult to qualify for the benefit, but boy the price is right.

  • by Ken MacCoy, CHS 2015-12-21 1:16:20 PM

    This is a prime example of the problem with the coverage provided by most 'association' plans. The price is appealing, but the client always gets exactly what they pay for: 'inferior accidental death & dismemberment (NOT disability) coverage.'

    While 'group insurance' provided by an employer would have been better than association coverage because it provides both accidental death & dismemberment AND disability coverage, the best option is always an individual & personally owned accident /or disability plan.

    So, while I commend Capri Insurance for stepping up and providing financial assistance; they can't be condemned for the coverage provided 'automatically' to those having a HCBC (Horse Council British Columbia) membership.

    Why? Group Insurance wasn't an option and it's the individual members responsibility to look into an individual plan.