Personal Injury

Disability

Employment

Estate Planning

more Personal Injury law
more disability law
more Employment law
more Estate Planning law

About Our Firm

Meet Matt Lalande

Community Involvement

FAQ

Hamilton Lawyers for Denied Critical Illness Payment Cases

Many insurance companies in Canada offer critical insurance policies. Critical illness insurance is individual plans that are primarily available in a free standing policy basis.  Most polices in Canada appear to cover the same 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. Most critical illness polices available in Canada offer some sort of 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 and internal illness.

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 a great number of survivors who make full recoveries.  Although many of these people survive physically, the financial outcome of any critical illness may reach beyond their available financial resources.

Due to the growing concern of consumers, a number of insurance companies over the past several years have began to offer 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 critical illness is diagnosed, you as the insured would receive a lump sum of money to use which ever which way you see fit.

What do critical illness policies cover?

Critical illness policies are primarily available on an individual basis (rather than as rider to another policy) and at least one insurer in Canada currently offers group critical insurance coverage.  Currently critical illness policies are issued either on the basis of 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.  Additional, premiums would be greater for those polices that cover more disease and conditions and/or that have more liberal definitions of the covered conditions.  Many critical illness policies offered in Canada appear to 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 is has progressed and the patients prognosis may all come into consideration in determining whether a given instance of cancer is covered by the critical illness policy.

What is the “big four” covered by most critical illness policies?

Most policies offer coverage of the “big four” – being heart attack, cancer, stroke and coronary bypass surgery.  Most critical illness policies offer coverage for insured’s who develop multiple sclerosis, kidney failure, major organ transplant, paralysis, blindness and deafness.  More comprehensive policies offer coverage over other critical illness.   If you have been denied critical illness insurance please contact us to protect your rights.

Denied critical illness payments in times of need

Unfortunately, many critical illness insurance carries deny their policy holders claims in times of need.  Many insurance carriers deny claims on based on misrepresentation.  For example when you apply for critical illness insurance, you have a duty to 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 doctors clinical entries.  Eventually cases resolved in favor 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 relay on as well as arguments that you as an insured policy holder do not suffer from a critical illness as defined in the policy.

Denied Critical Illness Payment Lawyers in Hamilton and all Ontario

Being denied critical illness benefits at time of need can be devastating to policy holder.  Reasonable denials or unreasonable delay in payment could cause a significant heightened anxiety, stress, panic and financial ruin for many individuals or families.  If you have been denied of your critical insurance benefit, please feel free to contact us.  Our consultations are free and we never change legal fees up front. Please call us at 905-333-8888 or fill in a contact form for more information.

tell us about your case

Request Your Free Consultation

We’re here to help. Schedule a free consultation with one of our experienced lawyers today by filling out the form below, or call us at 1-833-4-LAWFIRM

Submitted Icon

Thank you!

We've received your message and will follow up as soon as possible.

Lalande & Company Lawyers

Speaking with our Hamilton Personal Injury Lawyers  will not cost you anything. And if you retain us, we never ask for money upfront.



We’ll Come To You

Call us 24/7. We will travel to your rehabilitation center, home, or hospital, at your convenience.

Call Us Anytime

We are available to discuss your case anytime. Give us a call at 905-333-8888.

Free Consultation

Meeting and/or discussing your case with our firm lawyers is completely free.