What is critical illness insurance?
Critical illness insurance is an insurance product where the insurer is contracted to pay money (lump sum or structured) if the policyholder is diagnosed with one of the critical illnesses listed in the insurance policy.
These are ‘peace of mind’ contracts. The contract or policy will set out several definitions and terms. Contractual definitions and terms are almost always open to interpretation.
Most of these denials involve disputes over definitions of when a diagnosis of a critical illness is considered valid, allegations of misrepresentation, non-payment of premiums, and exclusion clauses.
Our insurance denial lawyers have successfully resolved denied critical illness claims by bringing forth the medical and collateral evidence required to resolve disputes over critical illness coverage.
Even in circumstances where the insurance company permits you to appeal the decision, it is still important to seek legal advice from a, insurance denial lawyer for the following reason:
YOU ONLY HAVE A LIMITED TIME WITHIN WHICH TO TAKE LEGAL ACTION. THIS IS CALLED A LIMITATION PERIOD. WHEN THE TIME LIMIT BEGINS TO RUN WILL DEPEND ON THE FACTS OF YOUR CASE.
Time limits are not the same for every policy and every circumstance and that is why it is essential to get legal advice to know what time limits apply in your particular circumstance.
Critical illness insurance is an insurance policy, in which the insurer is obligated to make a lump sum cash payment if the insured is diagnosed with a critical illness listed in the insurance policy. Conditions that are typically listed in a critical illness insurance policy are heart attack, stroke, cancer, multiple sclerosis, kidney failure, blindness, and other debilitating illnesses.
The most frequently relied upon reason for critical illness claims denial is misrepresentation on the application. In other words, the insurer alleges that insured person was not truthful about his or her medical history when they applied for the insurance.
As well, the definition of the critical illnesses listed in critical illness policies are becoming more narrow and more precise, which will likely lead to a higher incidence of claims denial and disputes as to whether the critical illness in question falls under the definition as set out in the policy.
There is a growing body of case law in Canada that shows that the Court often disagrees with the insurance company’s position on misrepresentation. Also, sometimes there are grounds to make a claim against a negligent insurance broker or advisor who advised about a critical illness insurance policy or sold the policy.
Maximizing the value of a critical illness claim is a complex task, and one which requires a great deal of skill and knowledge. Jan Fishman is a Vancouver Critical Illness Lawyer with the skill and knowledge you need to maximize a critical illness claim.
Has your critical illness claim been denied? Contact Jan Fishman and put his experience to work for you.
