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A critical illness insurance policy 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 policy can be very upsetting, particularly when you’re dealing with a critical illness at the same time and were relying on the financial support from your policy to help cover costs related to your illness. Whether providing much-needed money for expenses or using it to seek medical treatment not covered by the usual government health insurance plans, your payment is crucial. Our critical illness insurance lawyers can help you get the benefits you’re entitled to under your policy.
Get help with your critical illness insurance denial
After being denied your critical Illness insurance claim, you might not know where to turn next. You may feel hopeless at this moment, but rest assured that you’re not alone. When you call Share Lawyers, you will speak with someone who knows what it means to have your policy denied and can offer you the best possible advice at no cost to you. Our critical illness insurance lawyers are standing by to help you in your time of need.
Our critical illness insurance lawyers fight for you
David Share, President of Share Lawyers, on what critical illness insurance is, why critical illness claims are denied, and what Share Lawyers can do to help.
Critical illness insurance claims exist to pay out a defined lump-sum amount to the claimant in the event that they're diagnosed with a critical illness that will interfere with their day-to-day life.
These policies offer coverage for a whole host of serious illnesses. However, the particular way in which a critical illness insurance policy defines illness — including its severity — is often subject to review by insurance companies and their staff of medical professionals.
Why was my critical illness insurance claim denied?
Misrepresentation on original application for policy
Critical illness insurance policies are often purchased by individuals through licensed insurance agents or brokers. Some employer group benefit plans also contain this type of coverage, but the issue of misrepresentation most frequently occurs with an individual policy.
During the application process to purchase coverage, clients must typically complete an extensive medical questionnaire. Insurance companies regularly review the answers provided on this application to see if they can deny a claim based on false or inaccurate information.
If you believe that there was no error or omission regarding the information you provided, it may be possible to challenge the insurance company’s denial. You should contact one of our critical illness insurance lawyers to discuss your chances of success in pursuing the claim further.
Medical condition is not covered
If you bought this type of insurance, you were likely told that you would be paid out the value of your policy if you were diagnosed with one of the critical illnesses it covers. And yet, if you have been diagnosed with one of those covered illnesses, your claim may still be denied.
Sometimes the denial is based on a policyholder not contracting a severe enough form of the illness, as defined in the fine print of your policy. Your claim might also be denied because, while your illness appears to fall under one of the listed categories, the insurance company takes the position that it doesn’t fit squarely within the defined wording.
If your claim has been denied, a critical illness insurance lawyer is a powerful ally to have. Contract phrasing is often open to interpretation, as is the analysis regarding the severity or characterization of an illness.
Below is a typical list of covered illnesses*:
Multiple Sclerosis (MS)
Motor Neuron Disease
(*this list is only an example of covered illnesses and the list for your particular policy may differ, so always check the policy wording carefully).
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 requires new electrocardiogram (ECG) changes consistent with a heart attack. The claim was denied because the insurance company determined that the degree of ECG changes was insufficient to warrant a payout of the policy.
When discussing this with his doctors they believed that he should be entitled to the payout. What can he do to fight this?
This type of situation is one that Share Lawyers would review to evaluate the chance of success in pursuing the claim. A thorough review of the medical information that the insurance company reviewed, and any additional medical records they may have overlooked, would need to be conducted and experts consulted to determine whether the insurance company’s interpretation of the policy wording was too strict.
How much time do I have?
There are time limits to all disability claims and any delay in proceeding may be subject to a deadline, so you should not delay in pursuing your disability claim or obtaining legal advice to clarify these deadlines. We understand how important these timelines are and will respond to any call or email as soon as we can.
A critical illness insurance lawyer can help
Before accepting a refusal by an insurance company to pay out on your claim, we encourage you to consult further with our critical illness insurance lawyers to determine whether we can assist you in recovering all or part of what rightly belongs to you or your family.
Proudly helping clients with critical illness insurance claims
Are you looking for a disability lawyer to fight for your rights? Our law firm has unmatched experience in disability law and we don't let provincial borders stop us from helping you in your time of need. Your insurance company has a presence throughout Canada, so it makes sense to hire a disability law firm with well-established expertise in disability law—and a national presence, too. Your insurance company knows who we are and they know we won’t back down.
Regardless of whether you have just applied for your insurance benefits or have been denied your benefits by your insurance company and need support, we will talk you through all of your options—free of charge. It’s important to be informed about the insurance claim process and to know your rights.
No fees unless you win your case
We understand your situation and that paying for an insurance lawyer can feel out of reach. We are here to help you no matter where you are in the process. That is why we offer a free consultation, why there are no upfront costs to you, and why there are no fees unless you win your case. You’re not alone. We believe in your case, which is why we only get paid when you do.
When you work with us, you get guidance and tools to help you along the way. You will become a member of a privileged group of clients with access to our hub, called Life reBUILDER™, exclusively from Share Lawyers. It offers six unique services to help rebuild your life and get you back on track, beginning with the expertise of a full legal team all working for you.