By Marnie Luke and Diana Swain, CBC News
Canadian insurance companies are changing the wording in their policies and reviewing whether to remove controversial clauses in group and individual benefit plans that exclude coverage for people who try to kill or injure themselves.
The move comes after a recent CBC News investigation revealed that leading insurers such as Manulife, Desjardins, SunLife and Great-West Life can refuse to pay for treatment related to self-inflicted injuries and suicide attempts whether, as some policies state, the insured person was “sane or insane” at the time.
“Our member companies have agreed that this is an area that needs attention,” said the Canadian Life and Health Insurance Association (CLHIA) in an email to CBC News, noting that some of the 68 companies it represents have begun the move toward phasing out the exclusion clauses.
The association said that while it’s up to each insurer to take its own approach, “they are as a whole moving to ensure that both the language used and the exclusions being applied are up to date and in keeping with both the industry’s and Canadian society’s focus on responding to mental health issues in a fair, progressive and compassionate basis.”
It’s a significant shift from the response CBC News received when it contacted numerous insurance companies during an initial investigation two months ago.
At the time, responding through the association, they said insurance is meant to “protect people in the event of an unexpected injury or illness, and not for losses which result from the insured person’s deliberate actions.”
The association now says the CBC investigation prompted it to take “serious steps to move this issue forward” and that references to “sane or insane” will be removed as policies are renewed and updated because the language is considered “dated.”
Nearly 4,000 people die as a result of suicide across the country each year, according to Statistics Canada, and mental health professionals estimate up to 80,000 try to kill themselves.
Rejected payment a ‘slap in the face’
Mark Warder wants his story to bring life to those statistics.
The 46-year-old from Lion’s Head, Ont., was travelling in the United States for work last year when a sudden bout of severe depression made him want to “fall asleep and not wake up.”
After contacting his Canadian employer to say he wasn’t fit to continue driving, Warder pulled over and swallowed a handful of sleeping pills in an attempt to end his life.
A police crisis unit rushed him to a nearby hospital in Ohio, where he stayed for five days.
By the time he was discharged and given a bus ticket back to Ontario, he had accumulated $10,000 in hospital bills.
Both Warder and his employer were blindsided when the company’s insurer, SSQ Financial Group, refused to pay for his treatment.
“It’s kind of a slap in the face,” said Warder.
“It was kind of, ‘We’re glad you made it, but sorry for your luck. Here’s the bill.’ ”
Motivation to fight
While SSQ’s employee benefit plan does cover out-of-country medical expenses, the “suicide attempt” exclusion clause allowed the insurer to refuse payment.
“The claim was rejected because I got to the point of being suicidal. If I wasn’t that bad, the plan covers it,” Warder said, referring to the fact that he would qualify for treatment for depression.
He said he felt compelled to share his story after reading CBC’s report on suicide attempt and self-injury exclusions clauses.
“Let’s face it, most people if they’ve gone through this and [the insurance claim] gets turned down, they don’t have the motivation to fight it,” Warder said of his decision to go public about his ordeal.
Trudy VandenAkker, an insurance broker who worked with Warder and his employer on an unsuccessful appeal of his case, doesn’t think he should be forced to pay out of his own pocket.
“What was he supposed to do? He obviously had to get medical assistance and this policy should have actually covered him and been there for him,” she said.
Bill Wilkerson, a former executive in the insurance industry who now educates businesses on the impact of mental illness in the workplace, feels the clauses and language surrounding them are antiquated.
“It’s one of those hangovers from an ancient time of stigmatizing mental illness and viewing the destruction of someone under those circumstances as either a crime or a sin when it is neither,” he said.
The act of “committing suicide” was a crime in Canada until 1972.
The insurance industry association said it’s too early to provide a time frame for when exclusion clauses will be removed and could not provide details about which companies are moving in that direction.
According to Wendy Hope, vice-president of external relations for the association, group benefit packages are typically reviewed by insurers and their customers about once a year.
“While companies have begun the process of updating their policies, needless to say these changes will not occur at once but will be addressed as the policy wording and booklets are updated,” she said.
Wilkerson said while it’s a good start, he’s not optimistic the industry will take immediate steps to change, characterizing the association’s new position as “regrettably ponderous and opaque.”