What is critical illness insurance?
Critical illness insurance claims generally provide a lump sum payment as specified in the policy if you are diagnosed with a critical illness set out in the critical illness insurance policy.
Why would critical illness claims be denied?
Non-payment of a critical illness insurance benefits policy can be very upsetting, particularly as you are dealing with a serious illness at the same time and are relying on the financial resources from this policy to help you deal with your medical expenses.
Denied critical illness claims occur for a variety of reasons and to determine whether the denial can be challenged, a thorough review of the policy and medical information provided must be undertaken by a critical illness lawyer familiar with insurance law and insurance coverage.
Types of illness are very important to the insurance claims policy
It is important to understand that most critical illness insurance policies have a detailed description of the type of illnesses or conditions that qualify for payment. Being disabled from gainful employment may not be relevant to insurance coverage under a critical illness policy. Each policy has specific terms and conditions, which must be reviewed very carefully upon any coverage disputes.
In the insurance law industry, a critical illness policy is one that results in the loss of independence. Cancer, stroke, heart attack, heart surgery, kidney failure, organ transplantation, brain tumour, paralysis, coma, permanent disability, Alzheimer's, Parkinson's disease, and Multiple Sclerosis are typically covered conditions that will qualify you for critical illness insurance.
Watch out for the wording of your particular critical illness policy
The wording of your critical illness policy must be reviewed carefully to determine whether the specific illness you have will be covered or if you will be denied critical illness benefits.
Our insurance law group recently settled fair compensation for a client who was diagnosed with non-Hodgkin's lymphoma. The wording in critical illness policies is confusing and complicated - it's rarely as simple as sales agents in the insurance industry make it sound when the policy is first sold. Our client had applied for critical illness benefits from their insurance broker after they received their diagnosis. Living in Nova Scotia, they assumed that all of their medical expenses would be covered - but they soon found out that their insurance benefits were denied.
They appealed the decision by their insurer, giving them the benefit of the doubt that this must have been a simple error. But when they were denied again they contacted our critical illness lawyers for a free consultation.
When our Toronto critical illness lawyers looked into her critical illness claim, we saw on the small print that only several kinds of cancer were eligible for benefits within her critical illness policy, and that the policy would not cover illnesses not listed - including non-Hodgkin's lymphoma.
If a particular cancer diagnosis is not contained within the specifically defined medical conditions noted in your policy, then it is probably not covered for payment under the critical illness benefits policy. Our client found out the hard way - you must read the policy carefully or have it reviewed by your doctor or a critical illness lawyer to be sure.
Share Lawyers President David Share discusses critical illness insurance.
A critical illness lawyer wants you to know: common cancer limitations & exclusions
Often, any form of cancer is not covered in critical illness claims within the first 90 days of coverage. This 90 day waiting period begins on the date you are approved for coverage.
Often, certain forms of skin cancer, cancer in situ, T1A and T1B prostate cancer, or tumours in the presence of Human Immunodeficiency Virus (HIV) are not covered.
The good news is, insurance law states that, if the policy wording is unclear, the proper interpretation is to decide in favour of the claimant rather than the insurance company, as they drafted the wording. In any case, it's always best to consult an experienced critical illness insurance lawyer if you aren't sure.
At Share Lawyers, we can help you determine whether you have a case. We work on a contingency basis, and you don't pay any fees unless we win your case for your critical illness claim.
Denied your critical illness insurance claim?
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A note from our lawyers
Taking a medical leave from work is not an easy decision to make. Concerns about providing for yourself and your family and keeping your job may cause you to want to push through your pain, but this won’t make your problems go away. Stopping work is often the smartest decision for your long term health and well-being, and your disability benefits are there to provide you with financial support until you can return to work.
If you have made the tough decision to stop working and apply for your short term disability or long term disability benefits, you may feel overwhelmed by the process and have questions that your employer and your insurance company are not able or willing to answer. Share is There to see you through and answer your questions.
Our firm knows what you have been going through
We understand that things have not been easy for you over the last little while. Your health has been suffering, you are unable to work, and now your insurance company, who was supposed to be there in your time of need, has decided they will not pay your disability benefits or respect your disability claim. These benefits exist to provide you with the financial support you need so that you can focus on your health and rebuilding your life. It is unfortunate that your insurance company has not lived up to its promise. If your disability claim has been denied, we will fight to get you the benefits you are entitled to. Our disability lawyers have helped thousands of Canadians get their long term disability benefits over the past 35 years, and we can help you too.
Our experienced disability lawyers can fight back on your behalf
Share Lawyers believes that every client who is dealing with a disability claim deserves superior personal service. To achieve that goal, we have developed our team of experienced, compassionate, and caring long term disability lawyers, law clerks, and administrative staff to meet all of your needs. Our team of experienced long term disability, life insurance, employment, and critical illness insurance lawyers have made successful claims against many insurance companies, third-party administrators and employers.
If you are unable to work, your disability benefits should be there to provide you with the financial support you need. While your insurance company may be focused on finding ways to avoid paying your claim, our focus is on what is in your best interest. When Share Lawyers gets involved, you have an entire team of lawyers that are there to support you and to fight for what is yours.
Our disability claim lawyers fight for your disability insurance claim by relying on our many years of experience to apply the best strategic planning and approach in each case, using the latest technology available. Experience matters, and with Share Lawyers, you are in the best hands with 35 years of success on your side.