Have you or a family member recently been diagnosed with a serious illness or need surgery? Did you apply for benefits under your critical illness insurance policy only to be denied? Our Toronto critical illness lawyers can help you overturn the denial and get benefits paid. Call us at 647-424-4414 for a free claim review.
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Critical illness insurance is meant to provide financial assistance when you or a family member is suddenly unable to work because of a serious illness.
Unlike long-term disability benefits (which are paid monthly), the critical illness benefit is a one time payment. The amount of the payment is listed in your insurance policy and can vary widely.
To qualify for payment, the covered person must suffer an “illness, disorder or surgery” that is listed in the policy. The specifics will vary from policy to policy, but usually cover things like:
- Alzheimers disease
- Aortic surgery
- Benign brain tumour
- Coronary artery bipass surgery
- Heart attack
- Kidney failure
- Loss of speech
- Major organ failure
- Major organ transplant
- Multiple Sclerosis
- Occupational HIV infection
- Parkinson’s disease
- Severe Burns
Most critical illness policies also cover something known as “loss of independent existence.” This means the loss of independent ability to perform 2 or more activities of daily living, including bathing, dressing, toileting, bladder and bowel continence, moving and feeding.
Finally, your critical illness benefit is only paid if you live past the survival period, and have a loss of brain function. The survival period is usually 30 days.
How much is the critical illness payment?
The amount of the payment will be listed in the insurance policy. The amount can vary widely between policies. It can be as low as $10,000 or as high as $500,000 or more. The benefit is paid as a one-time payment. You have to get a copy of the insurance policy or group benefits plan to see the amount owing in your situation.
If you are having trouble getting the policy or group benefits booklet, contact us at 647-434-4414 for a free case review. As part of this review, we can write to your employer or insurance company to get a copy of the booklet or policy.
Who gets the critical illness payment?
The critical illness payment is normally paid to the person with the critical illness who is covered under the policy. However, if that person dies, the money is paid to their estate.
Why do Critical Illness Claims Get Denied?
There are common reasons why Insurance Companies will deny a life insurance claim. They will say that:
- your illness is a pre-existing condition and therefore not covered
- you misrepresented their health or financial situation when buying this insurance coverage
- your illness is not one of the “covered illnesses” under plan
- there was a technicality or mistake with the application
- you filed the claim to late and missed the deadline
- you didn’t give the right documents or paperwork
- your illness was intentionally self inflicted
- your illness happened during participation in a criminal offence
- your illness was the result of misuse of illegal drugs or alcohol
- your family member died during the survival period
Just because the insurance company denies based on one or more of the above reasons does not mean that it is true. You may know for a fact that the reason they are giving is not true. Our Halifax critical illness lawyers can help you get them to reverse their decision or have a judge order them to pay you.
Call us today at 647-424-4414 for a free claim evaluation. Our Halifax life insurance claim lawyers deliver these evaluations online and by phone, so you never have to go to an office.
As part of this free service we also get a copy of the insurance company’s claim file for you. This allows us to show you what is going on behind the scenes and give you a plan for getting the claim approved.
How to Appeal a Denial of Critical Illness Benefits
There are two levels of appeal for a critical illness denial. First, you start with asking the insurance company to reconsider its decision to deny the claim. This is called an internal appeal. Internal appeals can be successful if the denial is based on a technicality or missing information that is easily corrected.
The second level of appeal is called a legal appeal. This happens when you file a lawsuit against the insurance company. This sounds like a big step, but is actually quite easy for a lawyer to do. Your appeal then continues, but your claim will ultimately be decided by the court, rather than the insurance company. When handled properly, legal appeals can lead to settlements and claim approvals.
If the insurance company has already denied your critical illness claim, we strongly urge you to contact us for a free case evaluation before you take any further steps, sign more forms, or communicate with the insurance company.
Call us today at 647-424-4414 for a free claim evaluation to learn what an internal appeal or legal appeal would look like in your situation. Our Toronto critical illness lawyers will be honest with you about which option is best for you. We give you a plan for doing your appeal. You can then do it yourself or hire us to do it for you.
What Can a Toronto Critical Illness Lawyer Do For You?
Our Halifax critical illness claim lawyers can help you in the following ways:
- explain the real reasons your claim was denied
- explain what needs to happen to get the claim approved
- take over all communications with the insurance company
- give you a free claim review and plan for next steps
- gather information needed to support your claim
- represent you in doing an internal appeal with the insurance company
- represent you in doing a legal appeal (lawsuit) against the insurance company
Frequently Asked Questions
We handle all critical illness claim disputes on a contingency fee basis. There are no up-front payments. You only only pay us if we win. If we lose you don’t pay us anything and we have to write-off any expenses we incurred on your claim. Our fee is a percentage of the payout we get for you. We offer a 100% Satisfaction & Fair Fee Guarantee, so you can be certain our fee is fair and reasonable. Learn more about our pricing.
We cannot guarantee success in every case. It is possible we won’t be able to win your claim; However, most cases will resolve within twelve months with an out of court settlement or a claim approval. It can take longer than twelve months if the insurance company is not offering a fair settlement or you want to get the full amount owing under the policy.
here is no financial risk related out our legal fees or expenses. You only pay us if we win and collect money for you. However, there are risks of having to paying towards the insurance company’s legal fees and expenses if we lose. You have control over this risk because you will have opportunities to settle the case out of court. These settlements can include the insurance company paying a partial amount to you, or allowing you to drop the case without financial consequences.
The Rules of Court for Ontario require the losing side to make a payment toward the winning side’s legal fees and expenses. This is a partial reimbursement only. The insurance company will not have to pay a full reimbursement of your legal fees if we win or reach a settlement. We only charge legal fees based on a percentage of the money collected, so the legal fees will never be more than a percent of the money you get.Add question
Other disability claims services we offer:
- Long-term Disability Lawyers
- Short-term Disability Lawyers
- CPP Disability Lawyers
- Life Insurance Lawyers
- Disability Tax Credit Lawyers
Why Choose Resolute Legal?
We focus exclusively on disability claims, including critical illness claims. You will have the peace of mind knowing you are hiring a firm that only works in this area of the law.
We focus on educating you first, so you have all the information you need to make informed decisions. We know how stressful it can be to call a law firm, not knowing what to expect. This is why we have a dedicated support team to handle all incoming calls. Our support team is expecting your call and wants to hear your story.
We believe in full transparency and fairness with legal fees. We give you a 100% Satisfaction Guarantee. This means you can walk away in the first 45 days with no charges or questions asked. So, you don’t have to worry about buyer’s remorse when you hire us.
We also give you a Fair Fee Guarantee. When you hire a critical illness lawyer on a contingency fee basis (no win, no fee), the legal fee is a percentage of the funds recovered. While you should expect to pay a premium fee with this arrangement, there are limits to what is fair and reasonable.
The regulator for lawyers in Ontario has set out guidelines for lawyers to reduce a contingency fee when needed to ensure the fee is fair and reasonable. We follow these guidelines and reduce fees when appropriate. However, if you still think the fee is unfair, then we arrange for a Court Assessment Officer to review our fee. That officer has the authority to confirm or reduce the fee as needed to make it fair. This is how we guarantee a fair fee.
Finally, we have a dedicated disability claim support team. People on this team are trained to help people who call us. They are expecting your call and no question is a bad question. They will not pressure you to hire us. Their goal is to educate you and for you to have a positive experience.
So, don’t wait any longer. Give us a call today at 647-424-4414 for your free case review. We take calls 24/7. Or fill out the form on this page to get started.