Critical Illness Claims

Critical illness insurance benefits are supposed to be there when you need them most. If you are diagnosed with a serious illness or condition, this coverage will provide you with financial support while you recover.

Read on to learn more about critical illness claims and how you can get the help you need if your claim for benefits is denied or cut-off in Canada.

BASIC INFORMATION

What is critical illness insurance?

Critical illness insurance provides a lump-sum payout for people who are diagnosed with certain qualifying illnesses. Suffering from a critical illness can lead to a loss of income and the loss of quality of life, and benefits from this type of policy can help mitigate the financial loss that can result from certain illnesses, and can help cover medical expenses, or at-home care.

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What types of critical illness insurance are there?

Critical illness insurance is sometimes available through group benefit plans, such as part of a group benefits plan through an employer.

It is also available privately through an insurance broker. Critical illness insurance policies obtained privately tend to be more expensive, however.

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How does critical illness insurance work?

Unlike long-term disability benefits which pay out over a period of time, a critical illness claim can only be made once, and once approved delivers a one-time lump sum payment to the claimant. Insured individuals are subject to a survival period after a diagnosis is made before a claim can be paid out. Most survival periods last a minimum of 30 days, although it can vary depending on the type of illness a claimant is diagnosed with.

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What does critical illness insurance cover?

Critical illness insurance can cover illnesses such as:

• Heart attack
• Stroke
• Cancer
• Coronary artery bypass surgery
• Alzheimer’s disease
• Parkinson’s disease
• Major organ failure
• Multiple Sclerosis
• Paralysis
• Kidney Failure
• ALS
• Severe Burns
• Blindness

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What is the difference between critical illness insurance and long-term disability?

• Critical illness insurance provides a one-time lump-sum payout when a claimant is diagnosed with one of several illnesses specified in their policy, and once they have surpassed the survival period.
• Long-term disability insurance provides ongoing income replacement payments for individuals who are considered by their doctors to be unable to perform the essential tasks of their occupation. The length of the benefit period will differ by policy. Our firm also secures compensation for individuals who are denied long-term disability benefits.

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What you need to know before you file a critical illness claim

1. You need your doctor’s support

You can improve your chances of having your claim approved if you have your doctor’s full support. It is important to have objective medical test results to confirm your diagnosis, as needed and specified within your policy, to have a claim approved.

2. Have the policy in hand

Make sure you have a copy of your policy and have your doctor review the definition of the illness you are suffering from within your policy. This will help when you are making a claim, because your doctor will be aware of how the illness is defined in your policy and can make clinical observations in line with that definition.

Your policy may also include specific testing requirements depending on the diagnosis, so make sure your doctor has run all the proper tests and that those test results are included in your claim.

3. Be aware of critical illness exclusions

If you have experienced symptoms of your illness within a certain period of time prior to when you first apply for your critical illness insurance policy, and you are diagnosed and make a claim within the first year of holding the policy, then a pre-existing exclusion clause may prevent your claim from being approved.

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Why are critical illness claims denied?

Common reasons for critical illness claim denials include:

• Your illness is not covered because it is a pre-existing condition.
• You did not declare an illness when you applied for coverage.
• Your illness is not covered under your plan.
• There was an error in your application.
• You missed the deadline to file a claim.

While your insurance provider may refer to these or other reasons for denying your claim, you should never take their decision at face value. Have a critical illness lawyer at Samfiru Tumarkin LLP review your denial letter so we can understand their decision, explore your legal options, and get you the compensation you deserve.

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My critical illness claim was denied – what should I do?

If your claim has been denied it is important that you do not appeal your denial. Instead, reach out to a lawyer at Samfiru Tumarkin LLP as soon as possible, as there may be time limits to respond to your insurer that you are not aware of.

Critical illness policies are highly technical contracts and they require a legal expert to interpret and understand the details of the policy. Our team of experienced lawyers can help you get the compensation you are owed.

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How a lawyer at our firm can help

A lawyer can help you interpret your critical illness insurance policy and understand your rights. These policies are complex and written in confusing ways. We can help you cut through the legal jargon and understand what the best course of action is to ensure you get your benefits.

Don’t give up. That is what the insurance company wants you to do. They may also encourage you to appeal the denial. Do not go through the insurance company’s appeals process! In most cases, your appeal will be unsuccessful, and your insurer will use this tactic to run out the clock on your time limit to file a claim for full compensation.

If your critical illness insurance claim is denied in Canada, you need to contact the experienced lawyers at Samfiru Tumarkin LLP immediately at 1-855-821-5900 for a FREE CONSULTATION. We will review the facts of your situation, tell you if you have a case, and take the fight to the insurance company on your behalf. Don’t let them walk away with the money that they owe you in your time of need.

Get the advice you need, the compensation you deserve.