Terms of Service

Last Updated: May 20, 2026 Version: 1.1 (Lawyer-Reviewed) Effective Date: May 26, 2026

1. ACCEPTANCE OF TERMS

By accessing or using ClaimCoach North (the "Service"), you agree to be bound by these Terms of Service and our Privacy Policy. If you do not agree to any part of these terms, you may not use the Service.

ClaimCoach North is a bilingual (English and French) self-help document and information platform operated by ClaimCoach North, a sole proprietorship operated by Nicolas Faye, located in Ontario, Canada (referred to as "we," "us," "our," or "Company").

Note on Business Structure: We are currently operating as a sole proprietorship. We may incorporate as a corporation in the future. If we incorporate, these Terms will be updated to reflect the new entity.

2. WHAT WE ARE AND ARE NOT

2.1 We Are Not a Law Firm

This is important: ClaimCoach North is not a law firm. We do not provide legal services or legal advice. We do not represent you in any legal proceedings. We do not have lawyers on staff, and our service is not subject to solicitor-client privilege.

We do not:

• Assess the legal merits of your claim
• Interpret your legal rights
• Advise whether you should appeal
• Negotiate with insurers or benefits administrators
• Select legal arguments for you
• Tell you what outcome you are likely to receive

Any legal information provided is general public legal information only, not legal advice.

The documents and information we provide are tools to help you understand and respond to insurance denial letters and benefit decisions that you prepare, review, and submit yourself.

2.2 We Are Not a Medical Advisor

ClaimCoach North does not provide:

• Medical advice, diagnosis, or treatment recommendations
• Disability opinions or medical evidence opinions
• Medical interpretation of your health status

You should consult a physician or qualified health professional for medical advice, diagnosis, or treatment decisions.

2.3 Self-Help Tool

ClaimCoach North provides:

• Plain-language translations of insurance denial and benefit decision letters
• Structured intake forms to organize your information
• AI-assisted drafts of appeal letters based on your insurer's policy language and your medical evidence
• Educational resources about Canadian insurance and benefits appeals
• Access to appeal templates only where a specific insurer and denial category is active in the Service. During beta, paid appeal templates may be limited to Manulife long-term disability categories while Sun Life, Canada Life, and other templates remain on the roadmap or waitlist.

You remain responsible for:

• Reviewing all drafts before submission
• Editing and customizing any draft to reflect your actual situation
• Verifying the accuracy of information you provide
• Signing and submitting appeals in your own name
• Following all deadlines and procedures set by your insurer or benefits administrator

2.4 No Legal Representation

By using ClaimCoach North, you understand and agree that:

• We do not act as your lawyer or legal representative
• We do not attend hearings, negotiations, or appeals on your behalf
• We do not communicate with insurers or benefits administrators on your behalf
• We do not provide legal strategy, legal opinions, or legal advice
• We do not replace the need for a lawyer if your situation requires litigation or specialized legal advice
• We cannot guarantee that any appeal we help you draft will succeed

2.5 When You Should Consult a Lawyer

You should consult a licensed lawyer or paralegal if:

• Your appeal involves a legal dispute or litigation
• You believe you have been wrongly denied due to discrimination
• Your situation requires representation in court or before a tribunal
• You are uncertain whether an appeal is in your legal interest
• You need legal advice about your rights or obligations

We maintain a directory of Canadian disability lawyers and can help you find low-cost legal resources, but we do not provide legal guidance on whether you need one.

2.6 We Are Independent

ClaimCoach North is independent. We are not owned, controlled, funded, or endorsed by any insurer, employer, benefits administrator, government agency, or tribunal, unless clearly stated.

3. USE LICENSE

We grant you a limited, non-exclusive, revocable license to use the Service for your personal, non-commercial use only. You may not:

• Copy, modify, or create derivative works of our Service or content
• Reverse-engineer, decompile, or disassemble the Service
• Use the Service for any commercial purpose or in competition with ClaimCoach North
• Use the Service to scrape, bulk download, or extract data
• Use automated tools (bots, scrapers, spiders) without written permission
• Rent, lease, lend, sell, or transfer your access to the Service
• Use the Service in violation of applicable laws

4. YOUR ACCOUNT AND ACCOUNT SECURITY

4.1 Account Responsibilities

You are responsible for:

• Keeping your login credentials (username, password, and multi-factor authentication codes) confidential
• Preventing unauthorized access to your account
• All activity that occurs under your account

4.2 Notify Us of Unauthorized Access

You must notify us immediately if you believe your account has been compromised, by contacting support@claimcoachnorth.ca.

5. YOUR CONTENT AND RESPONSIBILITIES

5.1 Your Uploads

When you upload documents (denial letters, medical records, prescriptions, etc.) to ClaimCoach North, you:

• Confirm that you have the right to upload and share this information
• Confirm that you own or have permission to use all uploaded content
• Understand that uploaded documents may contain health information (PHI) protected under PIPEDA, PHIPA, and Quebec Law 25
• Understand that we will store and process this information according to our Privacy Policy
• Confirm that you may not upload information about other people without their legal authority, consent, or permission

5.2 What You Must Not Upload

You must not upload:

• Information about another person unless you have legal authority, consent, or permission
• Illegal content
• Malware, viruses, or harmful code
• False or forged documents
• Documents or information you are not allowed to share
• Third-party health or employment records without consent or authority

This is especially important because you may be uploading family members' health documents. You are responsible for ensuring you have authority to share this information.

5.3 Accuracy of Information

You are responsible for the accuracy and completeness of information you provide. We do not verify:

• Medical diagnoses or treatment history
• Insurance policy details or coverage terms
• Financial hardship claims
• Functional limitations or work capacity assessments

If our AI model generates drafts based on inaccurate information you provided, we are not liable for the consequences.

5.4 Your Use of Drafts

Before submitting any appeal letter or document drafted by ClaimCoach North, you must:

• Read it carefully and completely
• Edit it to reflect your actual situation
• Verify that all medical, financial, and personal information is accurate
• Confirm that the tone and language match your own voice
• Check for and correct any AI-generated errors or hallucinations
• Sign the final document as the true author

We strongly recommend you have a trusted friend, family member, or community legal clinic review the draft before submission.

6. AI-GENERATED CONTENT AND LIMITATIONS

6.1 How AI Works in ClaimCoach North

ClaimCoach North uses Anthropic's Claude large language model to:

• Translate denial letters into plain English or French
• Generate draft appeal letters based on insurer-specific templates
• Suggest responses to common denial reasons
• Organize medical and financial evidence

6.2 AI Limitations and Errors

You must understand these limitations:

• Hallucinations: AI may invent case citations, legal precedents, or facts that do not exist. You must never submit AI-generated legal citations without independently verifying them.
• Outdated information: The AI's training data has a cutoff date. Insurance policies, benefits programs, and regulations may have changed since then.
• Inaccuracy: The AI may misunderstand your situation, your insurer's policy language, or your medical evidence. The draft it generates may be inaccurate or incomplete.
• No personalization: The AI does not know your full story. It generates based on the information you upload, which may be incomplete.
• No judgment: The AI cannot assess whether an appeal is likely to succeed, whether you have a strong legal case, or whether a lawyer would recommend appealing.
• No medical judgment: The AI does not understand your specific medical situation and cannot provide medical opinions.

6.3 No Warranty on AI Output

ClaimCoach North provides AI-generated content "as is" with no warranty that it is accurate, complete, suitable for your situation, or will result in a successful appeal. You use AI-generated content entirely at your own risk.

7. LIMITATION OF LIABILITY

7.1 Disclaimer of Warranties

The Service is provided "as is" and "as available." We make no warranties, express or implied, including:

• Warranty of merchantability or fitness for a particular purpose
• Warranty that the Service is error-free, secure, or uninterrupted
• Warranty that any appeal drafted using our Service will succeed
• Warranty that our information is accurate, complete, or current
• Warranty that the Service meets your expectations or requirements

7.2 Limitation of Damages

To the maximum extent permitted by law:

• We are not liable for any indirect, incidental, special, consequential, or punitive damages, including lost wages, lost benefits, emotional distress, or loss of opportunity
• We are not liable for any damage or loss caused by errors in AI-generated content, even if we knew such errors might occur
• Our total liability for any claim arising from or related to the Service shall not exceed the amount you paid for the Service in the 12 months preceding the claim, or $100 CAD, whichever is greater
• We are not liable for delays, denials, or failures caused by your insurer or benefits administrator

7.3 Non-Waivable Liability

Nothing in these Terms limits liability that cannot be limited under applicable law, including liability for gross negligence, wilful misconduct, fraud, or statutory rights that cannot be waived.

8. REFUND POLICY

8.1 30-Day Refund Window

We offer a 30-day full refund on paid ClaimCoach North appeal services. If you are not satisfied for any reason, contact us within 30 days of purchase and we will refund the paid amount.

8.2 After 30 Days

After the first 30 days:

• If you have not downloaded the appeal PDF, you may request a full refund at any time
• If you downloaded the appeal PDF but have not submitted it to the insurer or benefit program, you may request a 50% refund within 60 days of purchase
• If you submitted the appeal to the insurer or benefit program, the work has been delivered and no refund is available unless required by law or approved by ClaimCoach North in exceptional circumstances

8.3 Draft Delivery SLA

If ClaimCoach North does not make your paid appeal draft available within 7 business days after payment and intake completion, we will issue a full refund. This SLA does not apply where delay is caused by missing customer information, customer inaction, unavailable payment processing, fraud review, or an event outside our reasonable control.

8.4 Cancellation and Refund Rights

This refund policy does not limit any refund, cancellation, chargeback, or statutory right you may have under applicable consumer protection law.

8.5 How to Request a Refund

To request a refund, contact us at support@claimcoachnorth.ca.

9. USER CONDUCT

You agree not to:

• Upload content that is illegal, defamatory, abusive, or violates someone else's rights
• Impersonate another person or misrepresent your identity
• Harass, threaten, or intimidate other users
• Upload malware, viruses, or harmful code
• Spam, phish, or attempt to gain unauthorized access to the Service
• Violate any applicable laws or regulations

We reserve the right to suspend or terminate your account if you violate these terms.

10. INTELLECTUAL PROPERTY

10.1 Our IP

ClaimCoach North, our logo, our insurer-specific appeal templates, our brand, and all content we create are our intellectual property. You may not use them without written permission.

Important: Names of insurers or benefit providers (Manulife, Sun Life, Canada Life, etc.) are used only to identify common appeal contexts, roadmap categories, template availability, or waitlist requests. ClaimCoach North is not affiliated with or endorsed by those organizations.

10.2 Your IP

You retain ownership of documents and information you upload. By uploading to ClaimCoach North, you grant us permission to:

• Store, process, and analyze your documents for the purpose of serving you
• Use anonymized, aggregated data from your appeals to improve our templates and Service (we will strip all identifying information)
• Retain your documents for 30 days after you delete them (for recovery purposes)

You do not grant us permission to sell your personal information or use your documents for marketing.

11. PRIVACY AND DATA PROTECTION

Your use of ClaimCoach North is governed by our Privacy Policy, which is incorporated into these Terms. By using the Service, you consent to our collection, use, and disclosure of your information as described in the Privacy Policy.

If these Terms conflict with the Privacy Policy on how personal information is collected, used, disclosed, retained, or protected, the Privacy Policy governs.

Key privacy commitments:

• We aim to store primary customer records in Canada where technically available
• Some service providers may process or store limited personal information outside Canada (see Privacy Policy for details)
• Health information (PHI) is encrypted at rest
• We do not sell or share your personal information with third parties
• You can request a copy of your data or deletion of your account at any time
• We comply with PIPEDA, and other applicable privacy laws

12. BILLING AND PAYMENT

12.1 Recurring Charges

If you subscribe to a monthly or annual plan, you authorize us to charge your payment method automatically on the renewal date. You must keep your payment information current.

12.2 Pre-Checkout Disclosure

Before you purchase, we will disclose:

• The price and billing frequency
• The renewal date
• How to cancel (easy to find and use)
• Refund terms
• Any appeal-specific charges or additional fees

12.3 Currency

All prices are in Canadian dollars (CAD).

12.4 Payment Processing

Payments are processed by Stripe, a third-party payment processor. Stripe is PCI compliant and encrypts your payment information. We never see your full credit card number.

12.5 Cancellation

If ClaimCoach North offers a subscription product in the future, you will be able to cancel it from your account settings. Cancellation would take effect at the end of the current billing period, and any refund would be handled under Section 8 and applicable consumer protection law.

13. SERVICE AVAILABILITY

We may modify, suspend, or discontinue any part of the Service at any time. We will make reasonable efforts to avoid disrupting paid users, but we do not guarantee continuous availability.

14. TERMINATION

We may suspend or terminate your access to the Service if you:

• Violate these Terms
• Engage in illegal activity
• Repeatedly upload frivolous or abusive content
• Use the Service in a way that harms other users or the Service itself

Termination is effective immediately. You may appeal a termination decision by contacting support@claimcoachnorth.ca within 7 days.

Upon termination:

• Your account and all uploads are deleted after 30 days
• You forfeit unused service access unless a refund is required under Section 8 or applicable law
• You may export your data within 30 days if you request it

15. THIRD-PARTY SERVICES AND LINKS

ClaimCoach North may link to third-party websites, resources, and services (lawyers, ombudsmen, government benefits portals, legal aid clinics). We are not responsible for:

• The content or accuracy of third-party sites
• Privacy practices of third-party sites
• Any harm or loss caused by using third-party services

Lawyer or resource listings are provided for convenience only. We do not endorse, guarantee, supervise, or receive referral fees from listed lawyers or organizations unless clearly disclosed.

We do not endorse third-party services by linking to them. You use third-party links at your own risk.

16. AGE AND GUARDIAN AUTHORIZATION

16.1 Age Requirement

You must be at least 18 years old to use the Service.

16.2 Guardian Authorization

A parent, legal guardian, or authorized representative may use the Service for another person only if they have legal authority to do so (e.g., power of attorney, guardianship). By using the Service on behalf of another person, you represent that you have such authority.

17. CHANGES TO THESE TERMS

We may update these Terms at any time. We will notify you of material changes by email or by posting a notice on the Service. Continued use of the Service after changes constitute your acceptance of the new Terms.

18. GOVERNING LAW AND DISPUTE RESOLUTION

18.1 Governing Law

These Terms are governed by the laws of Ontario, Canada, and the federal laws of Canada applicable in Ontario, without regard to conflict-of-law provisions.

18.2 Jurisdiction

Both you and ClaimCoach North agree to submit to the exclusive jurisdiction of the courts of Ontario for any legal action or proceeding, except as otherwise provided in these Terms.

18.3 Dispute Resolution

Before pursuing legal action, we encourage you to contact us at support@claimcoachnorth.ca to attempt informal resolution. If we cannot resolve your dispute within 30 days, either party may pursue legal remedies.

19. SEVERABILITY

If any provision of these Terms is found to be unenforceable, that provision will be severed, and the remaining provisions will continue in full force.

20. ENTIRE AGREEMENT

These Terms, together with our Privacy Policy and any policies referenced herein, constitute the entire agreement between you and ClaimCoach North. No other documents, communications, or verbal agreements are binding.

21. LANGUAGE

These Terms are available in English and French. For Quebec residents, a French version is available. If both versions are provided, the English version governs unless applicable law requires otherwise.

22. CONTACT US

If you have questions about these Terms, please contact us at:

ClaimCoach North Email: legal@claimcoachnorth.ca Email: support@claimcoachnorth.ca Website: claimcoachnorth.ca

APPENDIX A: UPL Disclaimer

What ClaimCoach North is:

• A self-help document tool
• A translator of insurance denial letters
• An appeal letter drafting assistant
• An educational resource about insurance and benefits

What ClaimCoach North is NOT:

• A law firm or legal service
• Your lawyer or legal representative
• A substitute for legal advice
• A guarantee of successful appeal
• Subject to Law Society of Ontario (LSO) regulation

Your responsibility:

• Review all drafts before submission
• Sign and submit your own appeals
• Edit drafts to match your situation
• Verify accuracy of all information
• Seek a lawyer if you need legal representation

By using ClaimCoach North, you confirm that you have read, understood, and agreed to these Terms of Service, including this UPL Disclaimer.

You further confirm that you understand ClaimCoach North is not a law firm and does not provide legal services or legal advice.