Denied a Critical Illness Payment?

Have you Been Wrongfully Denied a Critical Illness Payment? Call us today.

By Matt Lalande

What is critical illness insurance?

According to recent statistics Canadians are 10 times more likely to be unable to work due to a critical illness than die before the age of 65.  Most people do not realize that critical illnesses are affecting people in the prime of their working lives.  It is estimated that 1 in 2 heart attack victims is under the age of 65.  In addition, the incidence of cancer has risen traumatically, with a new case of cancer diagnosed every four minutes in Canada.  As alarming as these statistics may appear advances in medicine have produced a great number of survivors who make full recoveries.  Although many of these people survive physically, the financial outcome of any critical illness may reach beyond their available financial resources.

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Critical illness insurance is a specialized product – it is a type of a life insurance policy that provides a lump sum cash payment to a policy holder if he or she is diagnosed with a life-altering illness to help cover costs and other financial requirements while they cope with their illness. In other words, the product can provide a “financial cushion” per say, while you take time off to recover, pay for treatment or medical equipment ect. Many, if not most critical illness policies in Ontario provide substantial financial protection against over 25 to 10 medical illnesses and conditions. Critical illness policy lump sum payouts can range anywhere from $25,000 to $2M and available by most life carriers to Canadian citizens between the ages of 18 and 65.

What do critical illness policies cover?

Critical illness policies are primarily available on an individual basis (rather than as rider to another policy) and at least one insurer in Canada currently offers group critical insurance coverage.  Currently critical illness policies are issued either on the basis of a level premium for the life of the plan or as a guaranteed renewable 10 year term year.

Critical illness policy premiums are a function of the options selected in the range, sex, smoking status and the general health of the life insured.  Additional, premiums would be greater for those polices that cover more disease and conditions and/or that have more liberal definitions of the covered conditions.  Many critical illness policies offered in Canada appear to cover the same types of illnesses and conditions.  However, different policies may contain different definitions for a given condition or may vary in the degree of the condition required for a successful claim.  For example all policies in Canada have cancer as a covered condition, however the type of cancer, the degree to which is has progressed and the patients prognosis may all come into consideration in determining whether a given instance of cancer is covered by the critical illness policy.

Most critical illness policies available in Canada offer some sort of insurance coverage for something that we call “the big four” (heart attack, stroke, cancer and coronary bypass surgery). Many critical illness policies cover illness brought on by:

• heart attack
• cancer
• stroke
• coronary
• bypass surgery
• multiple sclerosis
• kidney failure
• organ transplant
• paralysis
• deafness
• blindness
• Parkinson’s disease
• Alzheimer’s disease
• motor neuron disease
• severe burns
• angioplasty
• occupationally acquire HIV
• severe mental illness.

Due to the growing concern of consumers, a number of insurance companies over the past several years have began to offer separate coverage for critical illness (care) insurance. This type of insurance is relatively new and the market is expanding rapidly, with new policies covering many additional illnesses.  Many advocates of disability insurance maintain that critical illness coverage is an important part of any comprehensive disability insurance package.  The main benefit of having critical illness insurance is that when critical illness is diagnosed, you as the insured would receive a lump sum of money to use which ever which way you see fit.

What is the “big four”?

Most policies offer coverage of the “big four” – being heart attack, cancer, stroke and coronary bypass surgery.  Most critical illness policies offer coverage for insured’s who develop multiple sclerosis, kidney failure, major organ transplant, paralysis, blindness and deafness.  More comprehensive policies offer coverage over other critical illness.   If you have been denied critical illness insurance please contact us to protect your rights.

Denied critical illness payments in times of need can send a claimant and his/her family into financial debt – and fast.

Unfortunately, many critical illness insurance carries deny their policy holders claims in times of need.  Many insurance carriers deny claims on based on misrepresentation.  For example when you apply for critical illness insurance, you have a duty to disclose any material facts asked for by an insurer on your critical illness application form or paramedical form used to provide further evidence of insurability to the insured’s underwriters.  An example of this could be a recent claim where a woman claimed payments under her critical illness policy after developing breast cancer.  The insurance company scrutinized her pre-diagnosis medical records and found that her doctor had mentioned “the lumpy breasts” on several occasions.  The doctor drew pictures of her breasts. The insurance denied critical illness payments based on the doctors clinical entries.  Eventually cases resolved in favor of the insured woman but this is a perfect example of how a critical illness policy can be denied based on disclosure issues.  Critical illness claims are also denied based on exclusionary clauses that insurance companies tend to relay on as well as arguments that you as an insured policy holder do not suffer from a critical illness as defined in the policy.  If you’ve been denied a critical illness payment, it’s important that you speak to a lawyer that specializes in critical illness insurance right away.

Denied Critical Illness Payment Lawyers in Hamilton – We serve all of Ontario.

Being denied critical illness benefits at time of need can be devastating to a policy holder.  Unreasonable denials or unreasonable delay in payment could cause significantly heightened anxiety, stress, panic and financial ruin for many individual claimants and their families.  If you have been denied your critical insurance benefit, please feel free to contact our critical illness lawyers in Hamilton serving Ontario. 

Critical illness claims are complex. Do not try and make the appeal a denied critical illness decision on your own. Hiring a knowledgeable critical illness lawyer with experience in litigating against every major Canadian critical illness insurance company is the best thing you can do.

We welcome your telephone call, live chat, email inquiry, form inquiry 24/7 and we would be happy to speak to you about your particular case.

Remember, we work on a contingency fee basis. This means that we do not get paid until we win your case. If we don’t, there are no fees charged to you.

Lalande Personal Injury Lawyers are critical illness lawyers who have been representing claimants who have been wrongfully denied critical illness payments since 2003. to. Please complete the contact form below or give us a call no matter where you are in Ontario at 1-844-LALANDE or local in the Hamilton / GTA at 905-333-8888. Otherwise, you can speak to our like chat operator or fill in a contact form and one of our Hamilton disability lawyers will get back to you within 24 hours.