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Toronto Critical Illness Lawyers
The Toronto critical illness lawyers at Verkhovets Law know that an internet search for critical illness insurance will show link after link to prospective insurers making warm, fuzzy promises to pay you a predetermined lump sum if the worst happens. But buried in the fine print is the very real prospect that if you are diagnosed with a dreaded disease, even if it’s on the list of approved illnesses, there are loopholes that could mean denial of the payment you’re owed – right when you need it.
Our Toronto critical illness lawyers have seen critical illness insurance sales continue to grow in recent years. That’s in line with statistics revealing that the incidence of many covered illnesses is increasing – and so is survival. While the diagnosis of cancers is rising, 60 per cent of Canadians recover, says the Canadian Cancer Society. That makes security blankets like critical illness insurance seem like good sense. But too often, claims are rejected, mostly alleging noncompliance with a specific illness definition or accusations of misrepresentation.
Why work with us?
Our Toronto critical illness lawyers explain
Why work with us?
Our Toronto critical illness lawyers explain
Why work with us? Our Toronto critical illness lawyers explain
Verkhovets Law, Toronto critical illness lawyers, understand that when you bought your critical illness insurance, you were probably told you’d have “peace of mind” if you ever needed to claim the one-time payment. So, if your policy is paid up and you have a heart attack tomorrow, it should be no problem to receive the money to handle financial gaps that can arise when living with a critical illness. After all, yours is on the policy’s list of approved illnesses. So, you’d think that you are covered, wouldn’t you?
Yes, you would – and should, say the Toronto critical illness lawyers at Verkhovets Law who have experience appealing insurance claim denials. We know how to handle these cases, challenging the policies with their tricky descriptions that seem like they’re deliberately written to confuse the public. We also understand that acceptance comes down to having a physician’s diagnosis of the illness and that it is the same as the one in the policy description – without the semantics.
Our Toronto critical illness lawyers note that the payment is with “no strings attached” and can be spent however the recipient would like without oversight. It’s generally thought of as a big fat emergency fund to protect you from having to dip into savings or retirements monies to pay for illness-related expenses.
Verkhovets Law, Toronto critical illness lawyers, have seen estimates that most Canadians live paycheque-to-paycheque so a critical illness without this benefit can be devastating, especially since the average age women make a claim is 49, while it’s 54 for men – prime time.
Some of the ways recipients use the payment include:
- Bridge until long-term disability insurance kicks in
- Keep your business in business
- Medical expenses not covered by OHIP
- Medications
- Maintain the family’s standard of living
- Pay off debts and credit cards
- Private nursing care
- Reduce your mortgage
Our Toronto critical illness lawyers
outline what may be covered
Our Toronto critical illness lawyers outline what may be covered
Verkhovets Law, Toronto critical illness lawyers, know that it’s becoming more likely that if you are diagnosed with a critical illness, you will recover. Your bank account, on the other hand, could be on life support by then because you haven’t been able to work. Having to pay out-of-pocket for a critical illness, even when you have insurance, can derail your retirement plans, too.
The Toronto critical illness lawyers at Verkhovets Law have seen how prevalent the four main covered critical illness conditions are in Canada. The numbers are sobering:
- Cancer: Nearly one in two people will get it in their lifetime, says the Canadian Cancer Society and 67 per cent of the claims that are paid are for this illness.
- Heart attack: Approximately 35,000 cardiac arrests happen each year in this country, says the Heart and Stroke Association of Canada (HASC).
- Heart bypass surgery: About 2.4 million Canadians have heart disease and 7,000 a month have the surgery in Ontario, notes Sunnybrook Hospital.
- Stroke: An estimated 62,000 strokes occur each year, according to the March of Dimes; 30,200 happen to women.
Verkhovets Law, Toronto critical illness insurance lawyers, explain that the list of
illnesses and diseases can vary between insurance companies, but there are many
in common. Payment is triggered by diagnoses of one of the serious illnesses on
the schedule, which may include:
illnesses and diseases can vary between insurance companies, but there are many
in common. Payment is triggered by diagnoses of one of the serious illnesses on
the schedule, which may include:
Verkhovets Law, Toronto critical illness insurance lawyers, explain that the list of illnesses and diseases can vary between insurance companies, but there are many in common. Payment is triggered by diagnoses of one of the serious illnesses on the schedule, which may include:
- Alzheimer’s Disease/Dementia
- Amyotrophic lateral sclerosis (ALS)
- Angioplasty
- Blindness
- Brain injury/benign tumor
- Burns
- Bypass Surgery
- Cancers (life threatening)
- Coma
- Lung disease
- Multiple sclerosis
- Organ failure
- Organ transplant
- Coronary artery bypass
- Deafness
- Heart attack
- HIV (occupationally acquired)
- Kidney failure
- Liver disease
- Loss of independent existence
- Loss of limbs
- Stroke
- Paralysis
- Parkinson’s disease
- Severe mental illness
Toronto critical illness lawyers define critical
illness insurance terms
Toronto critical illness lawyers define critical illness insurance terms
Survival period – Verkhovets Law, Toronto critical illness lawyers, say the term survival period refers to the minimum number of days that pass after the diagnosis of a covered illness during which the policyholder must not die, so the benefit is payable. If an individual is kept alive artificially, those days aren’t included. It’s not a death benefit, and won’t be paid to your family if you die before the period ends, typically between 30 to 180 days.
Loss of independent existence – Our Toronto critical illness lawyers note that loss of independent existence means the insured person has a critical illness and has been diagnosed by a doctor with the total inability to perform three of six listed activities of daily living for 90 days with no prospect of recovery. The activities include bathing, dressing, toileting, bowel and bladder continence, feeding, getting in and out of bed, chair, etc.
Exclusion clause – The Toronto critical illness lawyers at Verkhovets Law, define the term exclusion clause as the policy’s no-fly zone in terms of what is covered and what isn’t. Also known as the fine print, these clauses can include a no-go for pre-existing conditions; illness acquired while committing a crime; or, doing dangerous things like cliff diving.
Our Toronto critical illness lawyers explain
why payouts can get denied
Our Toronto critical illness lawyers explain why payouts can get denied
The Toronto critical illness lawyers of Verkhovets Law understand you’ve paid your critical illness insurance premiums faithfully for years. You felt safe all that time because you believed the insurer’s marketing slogan that they were your invisible suit of armour. Instead, in your time of need, they’ve left you without coverage by denying your claim. Why? Probably because you have fallen into one of the snares that are often tucked inside these policies.
Verkhovets Law, Toronto critical illness lawyers, know the most common reason insurers use to deny paying the claim is that the illness doesn’t fall within the specific definition in the policy. For example, you’ve been diagnosed with cancer, and your plan lists the illness as covered. But what gets missed is that the insurer limits payment based on the type of illness and description – they’ll cover in full for spreading cancer, but may deny altogether for a slow-moving disease or one that isn’t life-threatening. And you thought it was just for cancer, period.
Our Toronto critical illness lawyers have seen claims denied because the policyholder didn’t realize that an illness can be excluded if it’s caused by certain actions including substance abuse, failing to follow doctor’s orders, or even self-inflicted injury. Even though the illness is technically covered by the policy, the road map to exclusion is in the details.
The Toronto critical illness lawyers at Verkhovets Law note that another basis of denial is a pre-existing condition. Even if you didn’t lie, or it turns out the symptoms in question weren’t attributable to a particular illness at the time, an insurer may use them to deny if they were within a certain timeframe.
The Toronto critical illness lawyers at Verkhovets Law note other reasons for denial include:
- Deadlines missed to submit a claim
- Diagnosis that’s not clear
- Exclusion clauses
- Improper documentation or failure to provide your diagnosis
- Misrepresentation is alleged
- Unpaid premiums
Our Toronto critical illness lawyers
also handle these types of claims:
Our Toronto critical illness lawyers also handle these types of claims:
And our Toronto critical illness lawyers
will help you with these types of
personal injuries:
And our Toronto critical illness lawyers will help you with these types of personal injuries:
Broken bones
Concussions
Internal injuries
Soft tissue injuries
Whiplash
Call or email Verkhovets Law, Toronto critical illness lawyers and let us be your suit of armour.
Our Toronto critical illness lawyers know
how to handle insurer’s denials
Our Toronto critical illness lawyers know how to handle insurer’s denials
Verkhovets Law, Toronto critical illness lawyers, understand the fear and frustration of dealing with a terrifying, serious illness and receiving an intimidating letter from your insurer denying the critical illness insurance payment you thought you were getting. When this happens, we can step in and appeal the decision and if necessary, sue the insurer while you focus on your health.
Our Toronto critical illness lawyers follow strategies for appealing critical illness payment denials, including those based on a finding that an answer on the original form if it’s inaccurate. Depending upon the circumstances, we would argue the questions on the original application were vague, and you misunderstood their meaning. Or it could be there was miscommunication with the salesperson.
If your answers are accurate, but the insurer is misreading your medical history, it might be just an error that can be fixed.
But if it’s being done manipulatively to deny your critical illness claim, we would argue they’re acting in bad faith (intentional dishonesty by not fulfilling contractual obligations).
The Toronto critical illness lawyers at Verkhovets Law have seen the courts take on bad faith behaviour with respect to how some insurers handle claims. Under common law rules in Canada, insurance contracts create an obligation for both sides to treat each other in “utmost good faith.” The Supreme Court of Canada in the case Bhasin v. Harynew, 2014, set out the concept of good faith in insurance contracts, which means there are hard-and-fast rules that insurers should know.
Our Toronto critical illness lawyers note that a civil lawsuit in the Superior Court of Justice against the insurer may also include a claim for damages for bad faith, which are on top of the original policy claim.
Our Toronto critical illness lawyers will
fight for your rights
Our Toronto critical illness lawyers will fight for your rights
Verkhovets Law, Toronto critical illness lawyers, have seen insurers ramp things up and allege fraud in their bid to deny payment. But we know that if the illness happens two years or longer from when the policy was issued, the onus is on them to prove that you intentionally lied on the form. If the timeframe is within the two years, whether you lied or not is moot because all that’s important is the answer is wrong. So, if you made an innocent misstatement, we will fight this wrongful denial. Contact us today – we’re in your corner.
