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What to Do If Your Life Insurance Claim Is Declined in Canada

Having a life insurance claim declined is devastating, but it does not always mean the decision is final. Understanding why claims get declined and what steps you can take to appeal can help beneficiaries receive the benefits they are entitled to.

Common Reasons Life Insurance Claims Are Declined

The most frequent reasons include material misrepresentation on the application, lapse in premium payments, death during the contestability period (first two years), exclusions such as suicide within the contestability period, and engaging in undisclosed high-risk activities. Honest and complete disclosure during application is the best way to prevent future claim issues.

Steps to Appeal a Declined Life Insurance Claim

First, request a written explanation from the insurer detailing the specific reason for denial. Review the original policy documents carefully. Gather supporting documentation including medical records and correspondence. File a formal appeal with the insurance company. If the appeal is unsuccessful, contact the OmbudService for Life and Health Insurance (OLHI) for a free and impartial review.

How to Prevent Claim Problems from the Start

The best protection is a properly underwritten policy with complete and honest disclosure. Apluswealth advisors guide you through the application process to ensure accuracy, help you understand policy exclusions, and maintain your coverage in good standing. Prevention at the application stage saves your family from complications during a claim.