As a paying policyholder, it is incredibly frustrating when your insurance carrier decides to deny your critical illness insurance claim. You are suffering from the mental and physical pain of your illness, and now you are incredibly stressed about the overwhelming financial burden that is accumulating as a result. There are bills to pay, a mortgage, a family to support, and if you are a single parent or are self-employed, this can be even more detrimental to your well-being and your family’s quality of life.
Our Burlington critical illness lawyers are ready to assist you in navigating the appeal process for your denied claim. You still have options available, and you do not need to give up just yet. With a trusted, experienced legal team by your side like ours, you will be able to seek out the payment you deserve and achieve that peace of mind. As a policyholder, you may be entitled to the benefits you have paid into, and our experienced legal team is ready to help you get there. Book a free consultation with us and we will help you explore your options as soon as possible.
Critical illness insurance policies are offered to Canadians who require supplementary coverage in addition to other life insurance products that are offered either through a private insurance carrier or through their employer. When you are diagnosed with a life-altering, serious illness, you may receive a lump sum through your critical insurance policy that will provide financial support to you as you undergo the recovery process or shoulder the costs of living combined with treatment. In order to qualify to receive the payment, you must pass an initial survival period that is outlined by your policy.
Your individual critical illness insurance policy will determine which conditions are covered and the qualifying requirements to receive payment. Generally, all Canadian policies include coverage for the “big four”: cancer, heart attack, stroke, or coronary bypass surgery. Additionally, other conditions are commonly included, such as multiple sclerosis, paralysis, Alzheimer’s, and more. However, the specific coverage is determined by your carrier, and may become limited depending on the severity of the illness, survival rates, and treatment processes. Unlike disability insurance, critical illness insurance does not necessarily require you to be unable to work in order to receive a payout, but you may be denied for a variety of reasons depending on your carrier’s conclusions from their investigation process.
In Canada, 2.7 in 10 females and 3 in 10 males under the age of 65 will experience a critical illness. Therefore, critical illness can affect many working individuals who are in the prime of their working lives and are of the age in which working to save for a financial future is critical. The financial burden of falling seriously ill during this time can become substantial, and is therefore the reason that many Canadians opt to take out a critical illness insurance policy.
Critical illness insurance is a separate policy you can pay into, usually on a 10 year term, that provides claimants with a lump sum payment if you are diagnosed with a life altering illness. A critical illness policy can cover a variety of illnesses, including cancer, stroke, heart attack, coronary bypass surgery, Parkinson’s, AIDS, kidney failure, organ transplant, Alzheimer’s, and other major diseases. The illnesses covered will vary between insurance policies, but generally most Canadian policies cover the big four: cancer, stroke, heart attack, and coronary bypass surgery.
When you are diagnosed with a critical illness, there is generally a survival period outlined in your insurance policy you must undergo before you are able to collect your payment. The survival period may vary between policies, and can be anywhere from 14 days to 30 days. This means that the claimant must remain alive within the survival period in order to receive the policy. For example, if an individual suffers a heart attack and dies within a few days, they or their family may not be eligible for an insurance payout because the individual did not make it through the survival period.
Critical illness insurance and long-term disability benefits may sound similar in context but they are significantly different. A critical illness insurance policy will pay out a lump sum upon the diagnosis of a severe life-altering illness. Meanwhile, a long-term disability claim will provide monthly payment benefits for as long as the claimant is unable to work their own occupation, or any occupation if outlined after a 24 month period. Often, a critical illness insurance policy will cover some of the conditions that are not outlined within a disability insurance policy and can work in tandem with those benefits.
Another major factor that differentiates the type of benefits you may receive is your ability to work. A critical illness insurance payment is provided to the claimant regardless of whether or not the claimant is working, while a disability benefit payment is paid according to the claimant’s inability to work. If the individual is able to work, disability benefits may be denied or cut off.
Insurance companies are businesses and are not interested in paying out all of the claims that are filed, and therefore you will find that it is not in their best interest to assist you. Often, they will conduct their own investigations into your documentation, paperwork, and individual situation in order to prove that you are not eligible for your critical illness payment.
Some of the more common reasons that we have seen insurance carriers deny critical illness claims include:
It is important to work with medical professionals and disclose all of the documents surrounding your illness or condition in order to provide the strongest defence for your claim. A Newmarket critical insurance lawyer can go over those details with you to ensure you are not missing out on your payment due to minor errors.
When your insurance carrier denies your claim, it is up to you to determine if you would like to accept the denial or appeal the decision. For many claimants, accepting the denial means that you are opting not to deal with the stress of navigating insurance law, but it also comes with overwhelming financial burden as you attempt to accommodate your cost of living. However, you can appeal the denial immediately and gain a second shot at receiving your payout if you work with a Burlington critical illness lawyer.
You may file an appeal as soon as your claim is denied, giving you a chance to examine the details and determine the basis for the denial. Normally, you will receive the reasoning for your denial from your insurance carrier, which should provide you with an explanation. A Newmarket lawyer will go over those details with you and outline areas of opportunity to prove your claim. This can become a complex situation, and our legal expertise will be the strongest ally to you in your time of need.
It is possible to get your denial overturned. Our experienced Burlington critical illness lawyers are ready to help you receive the payment you need to help with your quality of life. We can assist in the complexities of your claim in order to provide you with the peace of mind needed to focus on your illness and recovery instead of shouldering the stress. The legal process can be intimidating for those with little experience, which is why it is our duty to take care of this for you.
One of the first things we will do is go over all of your paperwork and documentation to ensure that everything is filled out properly and no details are missed. We will also gather as much evidence as possible from medical specialists and health care workers in order to prove beyond a doubt that you are eligible for your critical illness payments. If necessary, we will assist you in elevating your appeal to the proper court or trial system and remain at your side throughout the process.
You are not alone in dealing with your critical illness insurance claim. OuBurlington critical illness lawyers are here to make your life easier and fight for the payment you deserve. Whether you need simple legal advice or you are ready to appeal your claim, get in touch with us for a free consultation. It is always in your best interest to examine your options, especially if there is a chance you can receive financial security. Contact us today at
I was a dental hygienist that suffers from really bad scoliosis. My insurance company ignored my doc & cut my benefits off & told me I could do “something”. Matt got me CPP Disability and and LTD settlement – I don’t know what I would have done without him.
My daughter was killed by a drunk driver and it forever changed all of our lives. It seemed that for two years time stopped. This was no an easy journey. Matt let me sit in on the discovery of the driver and boy, he never let up. In the end, our grand-daughter was taken care of and we were compensated for our loss – which we then donated to a cause we believed in.
I call Matt my knight in shining armour. After I was struck by a car while cycling and permanently crippled, he fielded all communications with my especially difficult and downright nasty insurance adjuster. Every step of my care was a battle and I did not have the strength to fight alone.
I lost my leg in a terrible motorcycle accident and Matt help me recover compensation I need because I could not work and the cost of prosthetics and rehab are out of this world. I don’t know what I would have done without him.
My brother ended up paralyzed after a car accident and Lalande did SO MUCH to help get things straight from him getting out of the hospital to all his care for life. We are so grateful for Matt & Heather. I don’t know how my family could have done this without them.
