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I would like to preface this conversion by mentioning that everything being discussed within this FAQs post is related to private group insurance benefits, and more specifically, with regards to complementary medicine services such as Osteopathy, and the governing of these insurance benefits by companies operating within the province of Quebec, Canada.

Over the course of the past decade, insurance companies have increasingly refused to provide payment for services rendered to their policyholders, under their extended private group insurance benefit plans; going so far as to defame practitioners as not being qualified, or claim that practitioners do not meet policy standards.

However, it should be known that it does not fall to the insurance company to dictate practitioner qualification, but rather, it falls to the professional governing body, who’s role is to oversee the legitimate practice of a profession.

Furthermore, the criteria insurance companies use to judge practitioners is aggregate, proprietary, and confidential information that is kept from both, professionals and policyholders alike, and as such, practitioners themselves do not know what criteria insurance companies are using when judging professional standards.

Moreover, an insurance company is governed by the Insurance Act, which means that it is expected to respect the terms of its policyholders’ contracts.

As private group insurance contracts are made up of three distinct parties: the employer, the insured, and the insurance company, should the insurer deny payment for services rendered by a member of a respected professional association within the scope of your insurance coverage, the service provider is unable to involve themselves, as they are not a party to the terms and conditions of the contract; because of this, many insurance companies refuse to speak with practitioners regarding rejected claims.

As such, only the parties involved within the insurance contract are legally entitled to take action regarding this matter.

For the reasons outlined above, should your insurance company refuse to reimburse your claim and refuse to honour the terms of your contract, regardless of the reason given by your insurance provider, you, as a party to the insurance contract, have the right to send a formal notice to the insurer, and contest this dispute before the Small Claims Court.

Lastly, since Antonio Colasurdo is not a distinct party of the private group insurance contract formed between your employer, yourself, and the insurance company, he cannot be held liable nor responsible in the event of an insurance non-reimbursement.

* The information provided should be considered for general information use only and should not be construed for legal advice, consulting, or any other form of professional advice. In all cases, you should consult with professional advisors familiar with your particular factual situation for advice concerning specific matters before making a decision. Please do not disregard advice provided by a professional advisor and/or lawyer because of something you have read on this page or website.