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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 many survivors who have fully recovered. Although many of these people survive physically, any critical illness’s financial outcome may exceed their available financial resources.
Critical illness insurance is a specialized product – a type of life insurance policy that provides a lump sum cash payment to a policyholder 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 se while you take time off to recover, pay for treatment or medical equipment, etc.
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 are 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 a rider to another policy), and at least one insurer in Canada currently offers group critical insurance coverage. Currently, essential policies of illness are issued either based on 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. Additionally, premiums would be greater for those policies that cover more diseases and conditions and/or have more liberal definitions of the covered conditions. Many critical illness policies offered in Canada 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 it has progressed, and the patient’s prognosis may all come into consideration in determining whether the critical illness policy covers a given instance of cancer.
Most critical illness policies available in Canada offer some 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 consumers’ growing concern, several insurance companies over the past several years have begun offering 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 a critical illness is diagnosed, you, as the insured, will receive a lump sum of money to use whichever way you see fit.
What is the “big four”?
Most policies offer coverage of the “big four” – a heart attack, cancer, stroke and coronary bypass surgery. Most critical illness policies offer coverage for insureds who develop multiple sclerosis, kidney failure, major organ transplant, paralysis, blindness and deafness. More comprehensive policies offer coverage over other critical illnesses. If you have been denied critical illness insurance, please get in touch with 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 carriers deny their policyholder’s claims in times of need. Many insurance carriers deny claims based on misrepresentation. For example, when you apply for critical illness insurance, you must 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 doctor’s clinical entries. Eventually, cases were resolved in favour 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 rely on and arguments that you, as an insured policyholder, do not suffer from a critical illness as defined in the policy. If you’ve been denied a critical illness payment, you must speak to a lawyer specializing in critical illness insurance immediately.
Denied Critical Illness Payment Lawyers in Hamilton – We serve all of Ontario.
Being denied critical illness benefits at a time of need can be devastating to a policyholder. 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 get in touch with our critical illness lawyers in Hamilton serving Ontario. Essential claims of illness are complex. Do not 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, or 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, you will not be charged a fee.
At Lalande Personal Injury Lawyers, we take pride in being trusted Hamilton personal injury lawyers since 2003. Over the years, we’ve helped our clients recover more than $45 Million in settlements and verdicts in personal injury, disability, and employment law cases. Whether you’re dealing with a life-changing injury, a denied disability claim, wrongful death, a hurt child or employment termination, we are here to provide compassionate and experienced legal representation. If you believe you have a case, call us today—we’re ready to help you secure the compensation you deserve.
Call Lalande Personal Injury Lawyers today, no matter where you are in Ontario at 905-333-8888 for your free consultation. Alternatively, you can contact us online, confidentially, by filling out a contact form.