June 2009 Archives

Over the past several years a large number of Critical Illness Insurance policies have been sold to Canadians either through private policies sold directly to them, or through group policies provided through employers or associations.    These policies are designed to pay a one-time lump sum benefit to an individual suffering from an illness set out within the policy.    The great misconception that members of the public have regarding these policies is that the benefit is paid out on the simple confirmation of the diagnosis of one of the listed illnesses.   

While payment may frequently be made without a significant fight with the insurer, rejection of such claims appears to be on the rise.   Claim denials are based on a number of potential factors, but we are seeing denials based on two principal areas:  1) The illness diagnosed does not appear to meet the criteria as defined in the policy; and 2) An allegation regarding a negligent or fraudulent misrepresentation regarding the individual's health status at the time the policy was applied for. 

If your claim for payment under a Critical Illness policy has been declined, you should contact a lawyer to discuss the possibility of challenging these decisions.   Our firm has years of experience in dealing with disputed insurance claims.  Familiarity with policy wording and underwriting requirements is crucial if you are to have any chance of success in disputing a claim rejection.