Critical Illness Insurance: What if I Have a Diagnosis of Cancer and the Insurance Company Says It’s Not the Right Type of Cancer?

Critical Illness Insurance: What if I Have a Diagnosis of Cancer and the Insurance Company Says It’s Not the Right Type of Cancer?

Under most policies, a critical illness is one that results in the loss of independence. Cancer, stroke, heart attack, heart surgery, kidney failure, organ transplantation, brain tumour, paralysis, coma, permanent disability, Alzheimer’s, Parkinson’s diseases, and Multiple Sclerosis may qualify you for insurance benefits.

That being said, the wording of your insurance policy must be reviewed very carefully to determine whether the type of cancer that has been diagnosed meets the criteria for a critical illness payout. The wording in critical illness policies is often confusing and complicated- it’s not as simple as sales agents made it sound when the policy was first sold. Even if you think you are covered, you might find out that your insurance won’t cover all of the costs involved, and even for those who are well-insured; Cancer can still become a massive financial burden.

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 Cancer diagnosis is 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.

Some common Cancer limitations and exclusions may include:

-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.

The good news is, the law states that, if the policy wording is unclear, the proper interpretation would be to decide in favour of the claimant rather than the insurance company, as they drafted the wording. In any case, it’s always best to consult an experienced insurance lawyer if you aren’t sure. At Share Lawyers, we can help you determine whether you have a case, and we won’t accept any fees unless you reach a fair settlement!

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. Find out if you have a Disability Case.