After reviewing the disability case of Samuel Archibald, Desjardins Insurance changed an earlier decision and has informed the claimant that he is now eligible for benefits.
An open letter by Archibald published in Montreal’s La Presse + prompted Desjardins Insurance to announce Feb. 12 that it was reviewing his case. In his letter, published Feb. 11, Archibald, an author and professor at the Université du Québec à Montréal, said he suffers from depression and recounted his battle with Desjardins Insurance, which had refused to pay his disability payments.
At the invitation of The Insurance and Investment Journal, Desjardins Group agreed to explain the reasons that led it to pay Samuel Archibald’s benefits following the review.
New information came to light
"It was in the light of new information, which was not in his file prior to his reassessment, that we were able to inform Mr. Samuel Archibald that he was eligible for disability benefits under his group insurance contract," stated Valérie Lamarre, spokesperson for Desjardins Group. She added that Desjardins is aware that this situation has had “unfortunate effects” for Archibald and that the organization is "sincerely sorry".
"If our teams had had all the information when the file was first assessed, or as part of a request for review, our decision would have been to pay the benefits,” Lamarre said. She added that this review process is available, offered and communicated to policyholders who wish to appeal a decision.
A rigorous process
She adds, on behalf of Desjardins, that the examination of a disability claim remains a "rigorous" progress which is based on the medical expertise and data in the insurer’s possession.
"Desjardins is particularly sensitive to the cause of mental illness,” Lamarre underlined. She added that a growing proportion of disability cases are due to mental illnesses. “It is a social issue that challenges us all: employees, employers, health professionals and insurers. So, as in all our spheres of activity, we will continue to see how we can improve.”