What are Common Limitations and Exclusions in Critical Illness Policies?

What are Common Limitations and Exclusions in Critical Illness Policies?

You might be wondering what the difference is between critical illness insurance and disability insurance? Don’t worry- Share Lawyers are here to help!

Critical illness insurance generally provides a lump sum payment as specified in the policy if you are diagnosed with an illness set out in the policy. It is important to understand that most critical illness policies have a detailed description of the type of illnesses or conditions that will qualify for the payment. Being disabled from gainful employment may not be relevant to entitlement to a payment under a Critical Illness policy. Each policy has specific terms and conditions, which must be reviewed very carefully.

If your particular critical illness is not on the list, or not contained within the specifically defined medical conditions noted in your policy, then it is probably not covered for a lump-sum payment under the policy. If you are unsure, you should read the policy carefully or have it reviewed by your doctor or a lawyer to be sure. The wording in critical illness policies is often confusing and certainly not as simple as sales agents make it sound when the policies are initially sold.

Some common limitations and exclusions may include:

-A covered condition that results from commission of a criminal offence; operation of a motor vehicle while intoxicated; self-inflicted injuries; use of alcohol, drugs or toxic substances; or acts of war.

-Often benefits will not be paid out unless the insured individual survives for a period of 30 days following the first diagnosis of a covered condition or any such longer period as specified in the policy.

-Often, any form of cancer is not covered within the first 90 days. This 90 day waiting period begins on the date you are approved for coverage.

-Often, certain forms of skin cancer, cancer in situ, T1A and T1B prostate cancer, or tumours in the presence of Human Immunodeficiency Virus (HIV) are not covered.

-Typically, Stroke is not covered if it results from external trauma.

No one plans to get sick, but when something unexpected happens, you can help yourself and your family by being financially prepared. Make sure you understand all the fine print in your critical illness insurance policy to ensure that your critical illness benefits will kick in when you need it the most!

Has your critical illness insurance claim been denied? Contact Share Lawyers and put our experience to work for you.

We have recently settled cases against The Co-operators, Sun Life, Manulife, Unum Canada and RBC Insurance.

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