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What Are Some Reasons My Critical Illness Claim Might Be Denied?

A critical illness insurance policy is designed to protect your finances in the event you are diagnosed with a life-altering condition such as a heart attack, stroke, or cancer.  These types of conditions can be extremely expensive to treat, and often restrict a patient’s ability to work and earn money as well.  So, the critical illness policy pays out a single large tax-free lump sum which can be used to pay for medical treatment, replace lost income, or put to any other use the recipient needs in their time of crisis.

Most of the time, the insurance benefits payout rapidly after diagnosis – generally within one month.  However, this is still contingent on the insurance company investigating the claim and deciding whether a critical illness is truly involved.  These are some of the factors that might cause them to deny a claim.

Three Situations Where A Critical Illness Insurance Claim Could Be Denied

  1. The condition is not covered

As with most types of insurance, there are different levels of coverage you can receive.  Some cover more illnesses and medical conditions than others.  If you became critically ill with a condition not covered by the policy, the claim would be denied.

Likewise, some severe illnesses may not reach the level of being critical illnesses and would therefore not be covered either.

  1. An unclear diagnosis

Your insurance company will be looking carefully at all the materials sent over by your doctor, containing their diagnosis and supporting evidence.  It is important your doctor be as thorough and precise as possible.  If their diagnosis does not fit the definition of critical illnesses covered by the policy, you could be denied.

In addition, hard documentation is expected.  Be sure to send any and all paperwork requested, to improve your chances of approval.

  1. Misrepresentation or non-disclosure on the paperwork

In short, if a person lied or left critical information off of their insurance paperwork, that would be grounds to deny the benefits.  For example, a person might omit a pre-existing condition to try to lower their premiums, but those sorts of omissions can lead to the policy itself being revoked.

Plus, of course, you need to be current on your insurance payments to keep the insurance policy active.

Contact Desjardins Financial Security Independent Network – Toronto West

Desjardins offers premium critical illness insurance in the Toronto area, covering up to 26 different medical conditions.  To protect yourself against a medical emergency, contact us for a free quote.

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