Critical Illness Insurance Claims in Canada – What You Need to Know

Critical illness insurance is meant to support you financially during one of the hardest times of your life. If you’re diagnosed with a serious illness like cancer, stroke, or heart disease, this type of policy can provide a tax-free lump sum payment to help cover expenses while you focus on recovery.

But when insurance companies deny or delay these claims, Canadians are left in a vulnerable and stressful situation. That’s where we come in.

At Samfiru Tumarkin LLP, we help Canadians in all provinces (except Quebec) get the compensation they’re owed when a critical illness insurance claim is denied. You can speak to us for free, and you don’t pay unless we win.

Table of Contents

What is Critical Illness Insurance?

Critical illness insurance is a type of coverage that pays you a lump sum if you’re diagnosed with a serious condition listed in your policy. Unlike long-term disability (LTD) benefits that replace monthly income, critical illness insurance gives you one payment, typically 30 days after your diagnosis.

You can use this money however you want:

• Medical treatment and private care
• Mortgage or rent payments
• Income replacement
• Childcare and household support
• Business continuity costs

⬆ Back To Top

What Does Critical Illness Insurance Cover?

Every policy is different, but most critical illness insurance plans cover:

• Cancer
• Heart attack
• Stroke
• Multiple sclerosis (MS)
• ALS (Lou Gehrig’s disease)
• Kidney failure
• Major organ transplant
• Coronary bypass surgery
• Parkinson’s disease
• Alzheimer’s disease
• Paralysis
• Blindness
• Severe burns

If your condition has also affected your ability to work, you may also be eligible for long-term disability benefits. It’s important to understand how your medical diagnosis may apply to both types of insurance claims.

It’s also crucial to review the policy definitions carefully. Many claims are denied because the insurer says the diagnosis doesn’t meet their specific definition.

⬆ Back To Top

Commons Reasons Why Claims Are Denied

Even if your diagnosis seems straightforward, your claim can still be denied. Common reasons include:

• The insurer says your condition doesn’t meet their definition
• They claim it’s a pre-existing condition
• You missed a filing deadline
• The insurer demands additional testing or unclear medical evidence
• You didn’t survive the required 30-day survival period

These denials can feel final – but they’re not. Don’t accept your insurer’s decision without speaking to a lawyer at Samfiru Tumarkin LLP.

⬆ Back To Top

Why You Shouldn’t Appeal a Denial on Your Own

Most insurance companies encourage you to appeal through their internal process. But this is often a dead end.

Here’s why:

• Appeals rarely work – the same insurer who denied you the first time is reviewing your appeal
• They may use the process to run out the clock on your legal rights

Instead, talk to a disability lawyer at Samfiru Tumarkin LLP who understands how to challenge these denials successfully.

⬆ Back To Top

Speak With a Critical Illness Lawyer in Canada

Our legal team handles critical illness insurance claims the same way we approach long-term disability cases – by cutting through insurer tactics and getting real results for our clients. On your behalf, we will:

• Review your denial letter and insurance policy in full
• Collect medical evidence and expert support
• Deal directly with the insurer or pursue a legal claim
• Charge nothing unless we recover money for you

A lawyer at Samfiru Tumarkin LLP can help you interpret your critical illness insurance policy and understand your rights. These policies are complex and often written in confusing language. We’ll help you make sense of it and determine your best path forward.

Don’t give up. That’s what the insurance company wants you to do. They may suggest appealing the denial through their own process, but in most cases, that only wastes time and works in their favour. Let us help.

If your critical illness insurance claim has been denied in Canada, speak with a critical illness lawyer at Samfiru Tumarkin LLP. We’ve helped thousands of people across the country recover compensation. Contact us now for a free consultation. We’ll assess your situation, explain your legal options, and work to get the money you are owed. You don’t pay unless we win.

⬆ Back To Top

Frequently Asked Questions

Is critical illness insurance worth it in Canada?

Yes. It can provide vital financial support if you become seriously ill, especially if you’re self-employed, have limited savings, or want extra security beyond LTD.

Is a critical illness payout taxable in Canada?

No. In most cases, the lump sum is tax-free, but speak with a tax professional if you’re unsure.

Can I get both critical illness and LTD benefits?

Yes, many Canadians receive both. Critical illness pays a lump sum, while LTD provides monthly income.

What if I already accepted a denial?

You may still have legal options. Contact us right away to review your situation.

How long do I have to take legal action?

There are strict time limits. You have two years from the date of denial to start a claim with help from Samfiru Tumarkin LLP.