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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 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.
How we can support you
After receiving a denial of your critical Illness insurance, you might not know where to turn next. You may feel hopeless in this moment, but rest assured you are not alone. When you call Share Lawyers, you will speak with someone who knows what you are going through and can offer you the best possible advice at no cost to you.
Why you should contact us:
- It’s free to talk to us
- There are no fees unless you win
- We specialize in critical illness claims and can go through your options
- We make arrangements for a free consultation with one of our critical illness claims lawyers to see how we can help you get your critical illness benefits
- We're there to answer all of your questions
Our lawyers can help with critical illness insurance denials
David Share, President of Share Lawyers, on what critical illness insurance is, why critical illness insurance claims are denied, and what Share Lawyers can do to help.
Critical illness insurance exists 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.
In these policies, there is coverage for a whole host of serious illnesses. However, the policy definitions of illness, including the severity of the illness, is often subject to review by the insurance companies and their 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. 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*:
- Heart attack
- Multiple Sclerosis (MS)
- Organ Transplants
- Kidney Failure
- 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.
We 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.
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 proceeding with 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.
Disability Lawyers in Toronto, proudly serving clients in Ontario and across Canada
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 and it makes sense to hire a disability law firm that has a true expertise in disability law and has a national presence too. Your insurance company knows who we are and knows that 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 that have 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.