Critical Illness Insurance

We offer a free consultation and no fees unless you win.

Critical illness insurance is a policy that pays out a one-time lump sum payment in the event that you are diagnosed with one of the critical illnesses included in your policy.

Non-payment of a critical illness insurance benefits policy can be very upsetting, particularly as you are dealing with a critical illness at the same time and were relying on the financial support from one of these policies to help you deal with your illness. Whether it is to provide much-needed money for expenses or to search for medical treatment not covered by the usual government health insurance plans the payment is crucial.

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.

Misrepresentation on Original Application for Policy

Critical illness insurance policies are often purchased by individuals through licensed insurance agents or brokers. Employer group benefit plans also sometimes contain this type of coverage, but the issue of misrepresentation most frequently occurs when an individual policy has been taken out.

During the application process to purchase the coverage an extensive medical questionnaire is completed, and answers given on this application are reviewed by the insurance company to see if they can deny the claim based on false or inaccurate information being provided.

If you believe that there was no error or omission regarding the information provided, it may be possible to challenge this decision and you should contact one of our critical illness lawyers to discuss whether there is any chance of success in pursuing the claim further.

Medical Condition is Not Covered

If you bought this insurance, you were likely told that you would be paid out the value of the insurance if you were diagnosed with one of the covered critical illnesses. If you have been diagnosed with one of the covered illnesses, your claim may still be denied.

Sometimes the denial is based on you not having a form of the illness that is severe enough as defined in the fine print of your policy, or your claim may be denied because while your illness appears to fall under one of the list categories, the insurance company takes the position that it doesn’t fit squarely within the defined wording.

If your claim has been denied, contact us to determine whether you can challenge the decision as contract wording is often open to interpretation as is the analysis regarding the severity or characterization of the illness.

Below is a typical list of covered illnesses*:

• Cancer
• Heart attack
• Stroke
• Blindness
• Alzheimer’s
• Multiple Sclerosis (MS)
• Organ Transplants
• Kidney Failure
• Paralysis
• Motor Neuron Disease

(*this list is only an example of covered illnesses and the list may differ in your particular policy, so always check the policy wording carefully).

Example: Illness Doesn’t Meet Definition in Policy

Here is an example of how a critical illness insurance claim may be denied. A 55-year-old man has critical illness insurance that provides coverage for a payout in the event he suffers a heart attack. While there was little doubt that he suffered a heart attack, the policy wording required new electrocardiogram (ECG) changes consistent with a heart attack. The claim was denied because the insurance company determined that the degree of ECG changes were not sufficient to warrant a pay out of the policy.

When discussing this with his doctors they believed that he should be entitled to the payout. What can you do to fight this?

This type of situation is one that Share Lawyers would review to see if there is a chance of success in pursuing the claim. A thorough review of the medical information that the insurance company reviewed as well as additional medical records they may have overlooked would have to be undertaken and experts would have to be consulted to determine whether the insurance company’s interpretation of the policy wording was too strict.

A Critical Illness Lawyer Can Help

Before accepting a refusal by an insurance company to pay out on a Critical Illness Policy, we encourage you to consult further with our lawyers for critical illness claims to determine whether we can assist you in recovering all or part of what rightly belongs to you or your family.