Critical lliness Insurance Claims
Learning About Critical Illness Insurance in Canada
Critical illness insurance is meant to provide you with a tax-free sum of money when you are diagnosed with a critical health condition outlined in your policy. These are usually life-changing diseases like cancer, heart attack, stroke, or illnesses like Parkinson's, multiple sclerosis, or loss of a limb.
This kind of insurance provides you with that available cash when you need it. Whether you use it to pay for the expenses of daily things, to pay bills such as your mortgage, or on private hospital treatment, it's all up to you. You are free to spend whatever you desire without limitation.
Why Choose Critical Illness Insurance?
While maybe some income still comes in from Employment Insurance (EI) sickness benefits or business sick days, that doesn't necessarily mean it is always enough to support your lifestyle or cover emergencies. The Canada Employment Insurance sickness benefit, for example, will pay only 55% of your weekly earnings, up to a maximum amount (as of 2024, that would be $668 a week), and for a maximum of 26 weeks.
Having things mapped out in advance for what you would do with your money if you were diagnosed with a life-threatening disease is a good idea—particularly if you have dependents or debt to be paid off.
What Are Covered Diseases?
Life insurance policies differ between insurers, but most insurers cover the "big three" illnesses: cancer, heart attack, and stroke. These are the most frequent claims. Some insurers cover such illnesses as:
- Alzheimer’s disease
- Kidney failure
- Major organ transplant
- Multiple sclerosis
- Loss of limbs or eyesight
- Parkinson’s disorder
One should read the terms of coverage before one purchases a policy since each insurance company is different when it comes to covering conditions and they may exclude or limit.
Heart Attacks & Stroke: Common Claim Reasons
Cardiovascular disease is among the most common conditions Canadians have to suffer from in order to qualify for critical illness benefits. Policies will typically, however, merely pay out for clinically diagnosed heart attack or stroke. For example, evidence such as abnormal cardiac enzymes or imaging (e.g., ECG) may be necessary in order to determine severity.
Cancer and Coverage Limitations
Another significant source of claims is for cancer. Insurers do not generally reimburse incipient or non-penetrating cancers (usually “stage 0” or “in situ”). Early-stage prostate cancer, for instance, will be excluded unless further along, a more aggressive Gleason score (usually 7 and higher). Limited reimbursement is allowed by a handful of enhanced policies for less aggressive cancers.
Suing in Canada: What Happens Next
Being critically ill can be daunting—especially if you’re in recovery. That’s why it seems like so many Canadians employ the services of claim support specialists. Specialists who handle all the communication with insurance companies, assist with paperwork, and follow up to prevent unnecessary delay.
The following is typically required to get things underway:
- Medical records verifying diagnosis (e.g., discharge summary or pathology)
- Your physician’s contact information
- Policy information (policy or schedule number)
- Two identification pieces
How long does it take to process a claim?
6 to 16 weeks average time is taken to process a claim in Canada, depending on the degree of complexity. Wait time may be due to waiting for a medical-type record or an insurer review, but all of the pieces of paper that a claim would need to advance as soon as possible keep it moving along.
Support For Rejected Claims
If your critical illness claim has been denied, do not despair. You may appeal a denial and, in Canada, even file a complaint to your insurer’s Ombud Service or sue. Expert claim help can get you additional evidence or prevail over unwarranted denials.
What Will We Do?
When you call us you will be assigned an individual claims consultant. Their role is to manage every aspect of your claim, provide regular updates on how your claim is progressing and be the main point of contact if you have any questions.
We will fill in all forms and speak to the insurance company on your behalf. We will regularly chase for information to be assessed and make sure they are no unnecessary delays.
Critical illness insurance can provide you with invaluable peace of mind when your health is on the line. In Canada, where healthcare expenses rise and there’s a chance to lose income for the duration of long-term illness, having that safety net available can be everything or nothing. When purchasing a policy or submitting a claim, having an expert guide you means you know what you’re getting and can concentrate on what is most important—your recovery.