Appeal Denied Health Insurance Claim Canada (Sun Life, Manulife)

If you have supplemental private insurance in Canada (like Sun Life, Manulife, or Canada Life) and they refuse coverage for prescription drugs, dental, or paramedical services, here is how to **appeal a denied health insurance claim in Canada**.

Internal Appeal Process

Canadian insurers typically have a 2 to 3 tier internal appeal process. Your first step is to submit new medical evidence from your Canadian physician. A short note saying "this is required" is not enough; your doctor must fill out a detailed functional assessment or medical necessity form.

OmbudService for Life & Health Insurance (OLHI)

If your internal appeals are exhausted, Canada offers an independent review board called the OLHI.

Provincial Plan Denials (OHIP, MSP, AHCIP)

If your provincial health plan denies out-of-country emergency coverage or an out-of-province specialized surgery, you must appeal to your Ministry of Health's specific appeal board (e.g., the Health Services Appeal and Review Board in Ontario).

Need help writing the letter? Use our Free Insurer Appeal Letter Generator to get started immediately.