Before I entered into the benefit world, our family quickly found out the importance of having a good benefit program in place when my dad had a heart transplant at the age of 43. I personally know what it’s like to be on the other side when your world gets turned upside down and know how important it is to have someone to lean on. I, along with my Apri colleagues, see our clients as people and make certain we always treat our clients in the way that we would want to be treated. I have often tried to put a price tag on the benefit program that helped our family in its time of need. Outside the obvious costs, what I can’t factor in is the piece of mind our family had knowing my dad would be taken care of and the additional worries taken off our plate, which allowed us to focus more importantly on my dad.

At Apri, our goal is to reach out and help as many Canadian families as possible. We want to be known as your trusted advisor, someone you can lean on in good times and when your world gets turned upside down.

We can’t help but become very attached to our clients and take it personally when we have to fight on their behalf where claims have initially been rejected. Even if this becomes an on-going battle, we won’t stop at the first ‘no’ on behalf of our client. For some outside our ‘family’, this might seem like over and above. I don’t look at it this way. It’s part of our culture and approach to helping our clients.

Our approach and our philosophies are built around our CARE approach. We become emotionally attached because we know how important employee benefits can play in our lives.”

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About a month later, I received a distraught voicemail from the employee explaining that her Critical Illness claim had been declined and she couldn’t understand why. When I spoke with her I told her I would investigate and get back to her. I contacted the insurance company and was told that the claim had been declined due to a contractual restriction (moratorium period) that specified “no benefit would be payable in relation to cancer if, within the first 90 days of the effective date of the coverage”. She was diagnosed mid-May.

When I called the employee back to explain the reason for the decline, I just couldn’t help but disagree with the contractual restriction on this type of benefit. I ended the call with her stating that I couldn’t promise anything, but would see if anything further could be done to have the decision reversed.

The situation was escalated to senior management at Apri. After some pressure, the insurance carrier agreed to review the claim again, and look at it outside of the moratorium period. Then they would decide if it would be an eligible claim. At this point, I was very optimistic that the employee would receive the CI benefit. The employee and I spoke back and forth about it on many occasions. In our discussions, I was cautiously optimistic as I didn’t want to set her up for disappointment, but deep down I really thought she was going to get a cheque.

Unfortunately, after the second review, the insurance carrier proceeded with a second decline based on another contractual restriction. This time, they were referencing the “pre-existing condition requirement”. The employee had gone to see a doctor regarding some symptoms in April, and was treated for a different condition that ultimately ended with her cancer diagnosis. The insurance carrier felt that this fell under the pre-existing clause and she was therefore declined.

Very disappointed, I advised the employee, who understandably was extremely upset. She expressed her concern not only for her life, but also her financial position and how she was going to be able to keep her home. I really had a hard time coming to terms with the decision of the carrier, but felt that our options at Apri were limited to help any further in this situation. For some time I still kept in touch with this employee, just to see how she was doing. We had come to terms and accepted that she would not be receiving any money for the CI benefit.

A month or so had gone by, and out of the blue I received a call from the Executive Vice President at Apri. He told me that he had continued to have discussions about this claim with senior management at the insurance carrier, as well as some of his old contacts, as he really felt that despite the contract, sometimes we have to just do the right thing. As a result of the Apri team’s persistence, the insurance carrier agreed to pay the claim. Unfortunately, it was not the full amount, but an amount big enough to definitely help out this employee in her time of need.

I had the privilege of being able to call the employee on a Friday evening, at 6:00 pm, to give her the great news. She was speechless and couldn’t believe that we had still been fighting on her behalf. Her husband was also on the call and his emotions had overtaken him. He did call me back to say thank you.

I still keep in touch with this employee as she continues to fight her cancer battle. She has told me she still has a lot of fight left in her.

For me, this story really signifies that everyone at Apri, beginning with our senior management, really stand behind what they say and truly CARE about people.”

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From the onset, I had concerns with the way in which the AD&D (Accidental Death & Disability) claim was being handled. Specifically, we felt that the contract wording is grey at best, and we believe that the underlying promise of the contract needed to be fulfilled. Further, I made the insurance company aware that Apri operates under a specific set of beliefs and values and that if the underlying wording or handling of the wording does not fulfill this belief system, then it would be very difficult for us to continue to place new business or manage existing business with any insurance company that operates in this manner.

They had verified that they had been served by the lawyers and had made the decision to follow through with the process of legal action. They believed that the wording was clear.

There was concern that we, at Apri, felt the wording was not clear and I was asked to explain. I gave several examples and the representative was, to her credit very open to taking the concerns back to the underwriting team, and was going to have the head of underwriting call me for further discussion. She did mention that she was not sure whether a payment would be made as an exception at this time, but given the information and concerns I provided her with, she was going to take it back to her team for consideration, and get back to me as soon as possible.

I also spoke with the daughter of the deceased man, who was in tears on the phone with me, not believing that we were willing to go above and beyond to help her. She voiced her joy and happiness at the help we had extended to her. She understands that we were doing our best to have the original promise of claim payment fulfilled.

I am pleased to be able to say we have just confirmed that the claim will now be paid. The family is ecstatic and, as they say, forever grateful.”

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The insurance carrier was the disability underwriter. I contacted the Disability Manager responsible for the ongoing management of this particular disability claimant. She advised me at the time, the employee’s psychiatrist (mental illness disability) had approved this individual’s return to work full time, and based on this information, had closed the file.

Following up on feedback from the employer (who does care about their employees) and were clearly concerned about this individual’s well being. I indicated to the insurance carrier that they needed to re-open the file and contact the psychiatrist responsible.

The insurance carrier was not getting a response from the psychiatrist, so I called several times and left numerous messages. My contact at the company, the Vice President of Human Resources, also contacted the psychiatrist several times and left several messages. Finally, the psychiatrist did return the V.P. of H.R.’s phone call and disputed the fact the employee was not able to return to work. In response, I then contacted a disability management company, who manages any ongoing short-term wage loss claims for this employer. They are not responsible for Long Term Disability claims – that remains the responsibility of the insurance company. I asked the disability management company if they would please provide an assessment of this individual on an ad hoc basis, as we are receiving conflicting opinions.

The disability management company got involved and did meet with the employee, as well as contacted the employee’s physician. The disability management company did indicate to the physician this employee was not fit to return to work and, in fact, may never be able to return to work based on the employee’s condition. The insurance carrier reopened the claim, and this employee is now back on Long Term Disability (probably will never return to work) and has regular appointments with her physician.

The employee lives alone and has no family in the city. The employer was very concerned that she did not have any support or an advocate to assist her with life in general. We contacted the disability management company to see if they would be interested in acting as this individual’s advocate on an ongoing basis. The employer was prepared to pay for the additional services. The disability management company agreed to act as the advocate and continues to keep in touch with her and guide her accordingly. The disability management company have helped her get involved doing volunteer work, so she is not at home alone, and she continues to stay involved with her community.

This story is a true example of 1) an employer caring; 2) an employer reaching out to us to ask for our help on how to assist and act on behalf of their employee. A disappointing fact is her own physician did not take the time to really understand her situation. This individual is truly disabled. She is no longer able to drive. If the employer had not stepped in, she could have done injury to herself or others, without really understanding why.”

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I will never forget how emotional it was driving to deliver the claim cheque to the employee’s widow on Christmas Eve. It really hit me how great a company I work with, and to what end we would go to honor a claim that would help alleviate any financial concerns his widow had while she dealt with her devastating loss.

I am reminded every day of this positive experience because I still have the personalized paper clip with their last name on it that the claim forms were clipped together with.

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After two months without a pathologist’s report, I received a call from the company that employed both deceased drivers. They explained that one of the drivers had a widow with three children and no other insurance. Without her husband she had no income, so the insurance proceeds were very important to her and the children.

This is when I got involved and spoke with the chief coroner in Toronto, who explained that the pathology report was to be sent from the pathologist at the hospital to the local coroner, then the chief coroner would receive it for review, and finally it would be sent to the insurance company.

After many phone calls to the local coroner and the pathologist to determine when the report would be received, it was clear that the pathologist was very backed up and it was going to take 6 months, at least. This was not acceptable to myself and least of all the wife of our client, so I dug a little deeper and determined that the police report had stated that the driver in question was actually not driving the truck at the time of the accident and was, in fact, asleep in the bunk when the accident happened. With this new information I was able to go back to the insurance company, without the pathologist’s report, and ask them to pay the claim to the surviving spouse, as they did not need the report if the driver was not the one driving the truck at the time of the accident.

The insurance company agreed and paid the claim to the surviving spouse, instead of waiting for the pathologists report, and likely saved the home and financial well being of the surviving family. Without someone to help, life would have certainly turned out very different for them, at least in the short term.”

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Never having met Jane, the policyholder, I contacted her to find out what was going on. Only then did I learn Jane was terminally ill and without financial resources to provide for her 2-year-old daughter. With all she had going on, Jane had forgotten that her ex-husband was still listed as the beneficiary on her policy.

I spoke with Jane to better understand her situation and her wishes first-hand. After our conversation, I was able to advise Jane on securing an advance payout on her policy. This enabled her to seek additional medical opinions. I also set things up so there was a trustee in place that would take care of her daughter’s inheritance once Jane was gone. Giving her peace of mind meant everything to me. It’s part of my philosophy of CARE.

After we ensured that her affairs were in order, Jane sent me a lovely thank you card. Sadly she passed away just days later. To this day, I still carry that card in my briefcase everywhere I go as a constant reminder.

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When I spoke to this young girl, she said simply “I need help”. Working with our client, I helped her to sort through everything. From the police report to the claims form, I was able to answer all of her questions. I couldn’t do everything I wanted to because of privacy issues, but I could at least walk her through everything step-by-step.

The situation was terrible and although I couldn’t change it, I found it deeply gratifying to at least be able to help, by stepping in to ease some of the burden for a young woman facing a distressing situation.

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I began by explaining the difference between contributing to their savings now, in the right way, compared to starting to save years down the road. As an example, I told them about two employees; a 22-year-old that starts contributing $2,000 a year to an RRSP and then stops in 10 years and the other, a 35-year-old that starts contributing $3,000 a year and keeps it up for 30 years. Ultimately, the younger employee will end up with the bigger nest egg, thanks to the power of starting early and compounding your savings. I overheard one employee remark to another, “I’m in.”

In the end we had 100% of the employees sign up. They got it! An outcome like that really excites me because it lets me know that I was really able to make a difference, giving them the information they needed to make a positive decision for today and for the future. I also left with the knowledge that 40 years from now, their lives will be better off for making the road to retirement a successful one.

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