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Denied Critical Illness Payments & Heart Disease

By Matt Lalande in Critical Illness on December 01, 2021

Denied Critical Illness Payments & Heart Disease

Suffering from heart disease is complex and frustrating. Individuals with various heart conditions are required to spend a significant amount of time and energy focusing on maintaining a lifestyle or treatment regimen that reduces the risk of heart failure, heart attack, or even possible death. Worrying about finances during this time is added strain that should be unnecessary. 

Heart disease is one of the four major areas of critical illness insurance coverage. If you or a loved one has been diagnosed with heart disease, you are able to make a claim if you have a critical illness insurance policy. This claim could entitle you to a lump sum payment that would assist in relieving financial strain and allowing you to focus on your quality of life during this difficult time. 

However, if your critical illness claim is denied, you may find the situation to be more frustrating than before. This is where a Hamilton disability lawyer can assist you. We have worked with a variety of clients throughout Ontario and assisted them in recovering their critical illness insurance payments, bringing them peace of mind and financial relief. 

The Dangers of Heart Disease in Canada

With over 2.4 million Canadians living with some form of heart disease, it is the second leading cause of death in Canada behind cancer. 

Heart disease is a blanket term used to describe a variety of conditions and diseases affecting the heart and posing a significant risk for heart failure, heart attack, stroke, and death. Generally, heart disease is caused by a blockage or buildup in the arteries, which results in a lack of blood flow and oxygen to the heart. It is the heart’s job to pump blood throughout the body, and when it is interrupted the results could be fatal. 

There are various types of heart disease and associated conditions that it can cause. These include: 

  • Ischemic heart disease
  • Heart attack
  • Angina
  • Structural heart disease 
  • Heart arrhythmia or irregular heartbeat
  • Coronary artery disease 

Risk Factors for Heart Disease 

There are a variety of risk factors that could contribute to an individual’s chances for developing heart disease and, ultimately, a potential heart attack or failure. Some are genetic and cannot be controlled, while others can be affected by a lifestyle or regimen change. 

Firstly, there are a variety of genetic and hereditary factors that can increase risk. A family history of individuals with heart disease can increase a risk, as can an individual’s age and ethnicity.

Secondly, a variety of lifestyle and external factors are also known to increase an individual’s risk of developing heart disease. These include:

  • Smoking 
  • Drinking heavily
  • Doing heavy drugs such as methamphetamines
  • Unhealthy diet
  • Obesity or being overweight 
  • High blood pressure 
  • Diabetes 
  • Excess stress 
  • Lack of exercise or physical activity
  • High cholesterol

What is Critical Illness Insurance?

Critical illness insurance is an optional insurance policy that can provide financial support to individuals suffering from major critical illnesses. Generally, Canadian critical illness insurance policies cover four main areas: cancer, heart disease, stroke, and coronary artery bypass surgery. Some policies may cover additional diseases or illnesses, such as multiple sclerosis, organ transplants, kidney failure, blindness, and paralysis. Most insurance companies are providing this insurance as an addition to the life insurance; additional premium payable for critical illness.

This type of insurance policy is designed to cover various areas that regular disability insurance benefits do not cover. Additionally, critical illness insurance differs from long-term disability benefits because it provides a lump sum payment instead of monthly income replacement payments. Unlike long-term disability insurance, critical illness insurance is not impacted if you are able to work and you will still receive a payout if you return to work. 

In order to receive your critical illness insurance payment, you must survive your diagnosis within a 30 day period. After this, you will receive the lump payment and are able to use it for your medical expenses, debt from lost income, or anything else you desire.

How do most Critical Illness policies define a “heart attack”?

A heart attack can happen when the normal supply blood to the heart is interrupted by a blocked artery or clot, causing part of the heart muscle to die. The usual symptoms include chest pain. The diagnosis of a heart attack therefore, is confirmed by the detection of abnormal electrical activity over the surface of the heart, which is normally seen on an ECG and the detection of raise levels of cardiac biochemical markers released from the damage heart muscle tissue.

Most critical illness policies define a heart attack as:

…a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall biochemical cardiac markers to levels considered diagnostic myocardial infarction, with at least one of the following:

  • Heart attack symptoms heart attack symptoms;
  • new electrocardiogram changes consistent with a heart attack;
  • development of new Q waves during or immediately following an intra-arterial cardiac procedure including but not limited to, coronary angiography and coronary angioplasty.

The diagnosis of a heart attack must be made by a specialist.

Most critical illness policies mandate that the insured person must survive for 30 days following the date of diagnosis.

Critical Illness Insurance can help during your time of recovery

Critical illness insurance benefits can provide much-needed financial support during your recovery time. This allows you to focus on your own well-being with the peace of mind that you are not spiraling into significant debt from lost income.

A lump sum payment can be a way of relieving stress that comes from various aspects of your condition. For example, you may have additional childcare costs if you are the primary caregiver, transportation costs or travel expenses for treatment, caregiver services if you require in-home care, and financial relief to pay bills or mortgage payments. 

You are free to use your critical illness insurance payment any way you choose, which can provide significant relief during this difficult time. However, critical illness insurance claims can often be difficult and your insurance carrier may deny your claim for a number of reasons. These reasons could be as minimal as a mistake on your paperwork to a lack of evidence of your heart disease. When this occurs, work with a Hamilton disability lawyer to appeal a denied claim and recover your critical illness insurance payment.

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

Unlike long-term disability claims, the determination of whether or not critical illness policy criteria is met is determined at the point at which diagnosis was made rather than on an ongoing basis. As such, it’s possible that a person completely recovers from the critical illness and is not impaired in any way but still meets the requirements under the policy for a covered critical illness at the time of diagnosis. Therefore, a claimant’s medical condition as it exists post diagnosis may be completely irrelevant to the analysis of whether or not the terms of the critical illness policy have been met.

Contact a Hamilton Disability Lawyer if You Have Been Denied Critical Illness Benefits For Your Heart Disease

Suffering from heart disease can be difficult, and being denied a critical illness insurance payment after paying into your policy for so long can be terribly frustrating. You deserve the financial peace of mind to ease your recovery and help support your family or household. Our Ontario Critical Illness Lawyers would be more than to review your particular situation  and provide you guidance on recovering your denied critical illness payment.

If you or a loved one has been denied a critical illness payment after suffering a heart attack or being diagnosed with heart disease, contact our Ontario critical illness lawyers today. We are based in Hamilton, but serve client with critical illness denial claim issues all over the province. Our consultations are completely free and if we determine that we can help your situation, we never ask for money upfront. Call us today, no matter where you are in Ontario at 1-844-LALANDE or local in the Burlington / Hamilton / Niagara areas AT 905-333-8888 tell . Alternatively, you can email through our website, confidentially and  we would be happy to get back to you within several hours.



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