Critical Illness Policies: Common Limitations & Exclusions

The difference between critical illness insurance & disability insurance

Critical illness insurance generally provides a lump sum payment as specified in the policy if you are diagnosed with an illness set out in the policy. It is important to understand that most critical illness policies have a detailed description of the type of illnesses or conditions that will qualify for the payment.

Being disabled from gainful employment may not be relevant to entitlement to a payment under a Critical Illness policy. Each policy has specific terms and conditions, which must be reviewed very carefully.

If your particular critical illness is not on the list, or not contained within the specifically defined medical conditions noted in your policy, then it is probably not covered for a lump-sum payment under the policy.

If you are unsure, you should read the policy carefully or have it reviewed by your doctor or a lawyer to be sure. The wording in critical illness policies is often confusing and certainly not as simple as sales agents make it sound when the policies are initially sold.

Some common limitations and exclusions may include:

-A covered condition that results from commission of a criminal offence; operation of a motor vehicle while intoxicated; self-inflicted injuries; use of alcohol, drugs or toxic substances; or acts of war

-Often benefits will not be paid out unless the insured individual survives for a period of 30 days following the first diagnosis of a covered condition or any such longer period as specified in the policy

-Often, any form of cancer is not covered within the first 90 days. 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

-Typically, stroke is not covered if it results from external trauma

No one plans to get sick, but when something unexpected happens, you can help yourself and your family by being financially prepared. Make sure you understand all the fine print in your critical illness insurance policy to ensure that your critical illness benefits will kick in when you need it the most!

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A note from our long term disability 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 disability law 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.


In this video, we explain the role of a long term disability lawyer and how we can support you when you have been denied your long term disability benefits.

Denied your long term disability claim?

Contact Share Lawyers today and put our experience to work for you. Our 35+ years of experience can help you win your case against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and other insurance companies. We offer free consultations and there are no fees unless you win your case. Join us on Facebook and become a Top Fan for a chance to win each month.








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