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The consumer had an accidental fall during their visit to Canada, which caused a dental crown to detach resulting in significant pain and discomfort.
The consumer made an emergency dental visit and the dentist determined that treatment was required.
The insurer denied the claim citing prior dental work was required and that this was not the result of an accident.
The consumer escalated the complaint, and the insurer maintained the denial, stating there was insufficient evidence to link the treatment to the accidental fall.
When speaking with the consumer, GIO suggested that they contact the dentist to provide further details about the nature of the emergency visit in writing.
These documents were obtained and GIO presented them to the insurer for further consideration.
After a review of this new information, the insurer agreed to process the claim and provide payment for the dental work that was completed.
GIO is an independent body set up to help Canadians find a fair resolution to disputes with insurance providers. GIO can provide advice on dealing with your insurance company as a first step. If you are not satisfied with the decision from your provider on your claim, GIO can help resolve your claim.
If you’d like to submit a claim visit here.
