About one-fourth of Canadians will suffer a critical illness some point in their life before they reach retirement age currently set at 65 years old. A critical illness can leave that person and his or her family in a stressful financial bind which compounds the emotional and physical stress of the illness.
Claims for critical illness benefits are often denied by critical illness insurers. If you have any question that your claim for critical illness benefits should have been paid, contact Geoff Aylward, experienced, reputable Critical Illness Insurance Dispute Lawyer in Newfoundland and Labrador. His practice is focused primarily on personal injury, medical malpractice, and insurance dispute matters. His legal counsel can help reduce your stress while he works to protect your rights.
Critical Illness Insurance: the Basics
Critical illness insurance is coverage for persons who acquire or contract a critical illness as defined under the terms of the Policy. Generally, the illness must be severe, require significant medical evaluation and intervention and impair the person's functional ability. This insurance policy is often purchased in increments of 10 years to the age of 75 or 100, with some policies offering the option to lock-in premiums. The most common amount is $100,000.
The questions on the application form must be answered honestly and accurately. If there is a mistake, the insurer may rely upon that as a misrepresentation to deny coverage for any critical illness. Generally, an innocent mistake will not result in a denial if the policy has been in effect for a period of two years at the time of the critical illness. However, a deliberate concealment of a pre-existing medical condition or other deliberate misrepresentation on the application form (such as a smoker claiming to be a non-smoker) could result in a complete denial of benefits even after you have paid many years of premiums.
Though each policy presents its own specific definition of critical illness, it usually includes a set of narrowly defined diseases or conditions, such as:
- Heart attack
- Multiple sclerosis
- Parkinson's Disease
- Renal failure
- Severe burns
Your illness is generally the primary factor considered by the critical illness insurance company when it determines if you are eligible to receive the benefits. Unlike disability insurance, your eligibility to file a critical illness claim is not dependent on your inability to work and you can collect the full amount of your critical illness benefit even if you fully recover. Some critical illness policies will be more inclusive while others are more restrictive. If you know your family's medical background, you may want to ascertain hereditary diseases or conditions and ensure they are included in your policy. It is important that the application for critical illness benefits be completed accurately. If there is an applicable pre-existing condition, disclose it in the application. That type of illness may be excluded as a pre-existing condition; a higher premium may be charged, or there may be a waiting period during which you had a clean bill of health before the coverage applies.
In addition to what exactly the critical illness insurance policy covers, most policies provide a lump sum tax-free. The benefits can be used to pay the mortgage, therapy, and other bills or costs. There are, like all insurance claim processes, deadlines to be met when filing a claim, an appeal, or a lawsuit.
Critical Illness Claims: Disputed & Denied Benefits
You purchased critical illness to cushion financial consequences associated with a critical illness. You probably understood that you would be covered in the event you suffered any severe illness, after all, most people consider a "serious" illness to be a critical illness.
Years after monthly premium payments you may suffer a serious illness. You file the application along with doctors and hospital records. Then you receive a letter from the insurer denying your claim for benefits.
Typical reasons for denied claims include but are not limited to the following:
- Acute condition does not meet the technical definition of critical illness contained in the policy.
- Hospital or medical records do not meet the criteria for the specific critical illness as the term is defined in the policy.
- Your physician has not provided sufficient medical evidence to establish or prove your critical illness.
- There is incomplete or inaccurate information provided in the claim application.
Conditions of critical illnesses as defined by your policy may be narrowly defined. The requirements to prove that you suffered a critical illness are extensive. For example, a heart attack may be included, but to claim benefits on that heart attack, certain conditions must be present: death of heart muscle due to obstruction of blood flow, the obstruction of blood flow must create a rise and fall of biochemical cardiac markers, the biochemical cardiac markers must rise to levels considered diagnostic of myocardial infarction. If the required conditions are not present, then your heart attack may not qualify you for benefits.
Fighting critical illness disputes and denials are difficult and require legal representation from an experienced lawyer who knows the relevant laws, understands the insurance industry and its processes, and recognizes a case that can win on appeal or at litigation so your time and energy is not wasted more than what it already has been.
There are strict time limits for filing an application for critical illness benefits and for filing legal action if the insurer has denied the application for benefits. If your claim has been denied or you are uncertain about how to pursue your claim, contact an experienced critical illness insurance lawyer like Geoff Aylward, QC.
Comprehensive, Compassionate Insurance Dispute Lawyer
Have you been denied Critical Illness benefits? Critical illness insurance dispute lawyer Geoff Aylward offers strong advocacy and legal counsel in your fight to obtain the compensation you are entitled. He focuses on personal injury, insurance dispute and malpractice matters in Newfoundland and Labrador. He knows how to deal with the tactics used by insurance companies to stall and deny claims.
Equipped with experience, keen insight, and compassion, lawyer Geoff Aylward, QC is available to review and address your critical illness insurance concerns. Contact Geoff Aylward today either online or at 709-726-7260.