Critical Illness Insurance Denial Lawyers
When someone is diagnosed with a critical illness, they have enough to deal with without being concerned about financial issues. How is your family going to afford to pay for the day-to-day costs of living? The mortgage? Groceries? What about childcare? Critical illness insurance is “peace of mind” insurance and not having to worry about these issues is exactly why people get critical illness insurance in the first place. This is what makes a denial of a legitimate critical illness claim all the more devastating.
What is Critical Illness Insurance?
Critical illness insurance is an insurance product that provides coverage for a very specific group of illnesses that are listed in an insurance policy. Many people think that critical illness insurance covers any illness if it is severe enough, but that is not the case. The illness needs to be specifically listed in the policy in order to be covered.
Examples of conditions that are often covered under a critical illness policy are:
- Heart attack
- Loss of sight
- Cancer (often specific to the type)
- Alzheimer’s disease
- Loss of hearing
- Motor neuron disease
- Benign brain tumour
- Loss of limbs
- Loss of speech
- Brain injury
- Major organ failure or transplant
- Multiple sclerosis
- Parkinson’s disease
- Severe burns
These are just examples of some of the most common illnesses covered under critical illness insurance policies.
Critical illness insurance is a very policy specific type of insurance, and the exact wording of your policy will determine your rights and the insurance company’s obligations. Some policies have what is called a “survivor period”, which is a minimum timeline in which an insured under the policy needs to survive from the initial diagnosis of the illness to have coverage for a payout of benefits under the policy. Other policies may require a specific type of medical specialist to make the diagnosis an insured is relying on to seek benefits under the policy.
Common Reasons Critical Illness Claims Get Denied
Critical illness insurance is often a much more contract specific area of the insurance world when it comes to denials of coverage. This is because while the type of coverage sounds quite wide in its application, the policies are specifically designed to be narrow in their application, making the coverage inapplicable for many illnesses that the average person would consider “critical”.
The most common reasons critical illness insurance claims get denied are:
- a misrepresentation in the application for insurance coverage
- a fraudulent representation in the application for insurance coverage
- a failure to adhere to the specific terms of your policy
- your illness is caused by a pre-existing condition excluded by the terms of the policy
- your illness is not specifically listed as a covered condition under your policy
- an improper or vague diagnosis by your doctor
Has Your Critical Illness Insurance Claim Been Denied?
Just because your critical illness insurance claim has been denied doesn’t mean you are out of options.
If your critical illness insurance claim is denied, your family’s financial security becomes a distraction when you should be focusing on your health. Critical claims are denied for various reasons. Most commonly the insurance company will argue that there was a misrepresentation in the insurance application. These arguments often include complicated legal language, exclusions, and restrictions in the policy. Make sure you get a lawyer who can explain the issues to you in plain language that you understand.
Critical illness claims are often denied while the insured are still recovering from their illness, leading to added stress and trauma. Speaking with an experienced team of insurance denial lawyers can give you peace of mind and insight into your options. The lawyers at Taylor & Blair LLP will review your policy and claim application, the facts surrounding your illness, and help you plan your next steps.
Critical Illness Insurance Denial Claims & Timelines
If you have been denied your legitimate critical illness insurance claim and you want to force your insurance company to pay you the insurance benefits you are entitled to
If you receive notice of an insurance claim denial, it’s important to act quickly if you wish to take legal action. There are limitation periods to keep in mind, so please contact us as soon as possible so our team can help you navigate your legal options.