How to Handle Critical Illness Insurance Denials in BC
Has your critical illness claim recently been rejected? A B.C. insurance denial lawyer can help. Keep reading to learn more.
What is Critical Illness Insurance?
Critical illness insurance provides financial protection for individuals who have paid their premiums and hold a policy covering specific major illnesses. This coverage offers a one-time, lump-sum payment if you are diagnosed with and survive a covered condition defined by your policy. This payment is designed to help you with medical costs, lost income, and other expenses incurred during your illness.
Common conditions covered under these policies include:
- Cancer
- Heart attacks
- Stroke
- Kidney failure
- Major organ transplants
- Blindness
- Multiple sclerosis
- Paralysis
Why Do Critical Illness Claims Get Denied?
Critical illness claims can face denials for many reasons, including but not limited to the following:
Material Misrepresentation
Material misrepresentation is the most common cause of insurance denials, regardless of policy type. This denial occurs when an insurer believes that you have made a misrepresentation in your insurance application by providing information that is not accurate, even if you do so unintentionally. Crucially, the insurer can void your policy even if your misrepresentation is entirely unrelated to your critical illness.
Exclusion Clauses
While your critical illness insurance policy offers certain protections, it will also contain many exclusions, which are not covered under the policy. Common exclusions include:
- Pre-existing conditions.
- Conditions related to alcohol or drug use.
- Self-inflicted injuries.
- Injuries sustained from criminal activities.
- Chronic conditions, including asthma or fibromyalgia.
Policy Waiting Periods
Most critical illness policies include waiting periods between when the policy is purchased and when coverage becomes effective. These waiting periods can range from 30 to 90 days, depending on the specific condition and policy terms. For complex illnesses, the initial date when symptoms first started developing and when an official diagnosis was received can be hard to pinpoint. If your insurance provider believes you developed symptoms during the waiting period, your claim might be denied.
What are the Possible Solutions to a Denied Claim?
Are you wondering what you can do if your insurance company denies your insurance claim? The lawyers at Rice Harbut and Elliott LLP are here to help. When navigating denied claims, here are some ways we can help:
Review Your Denial
Insurance policies are often long and difficult to understand, which can make dealing with your insurance denial even more overwhelming.
When you work with us, our lawyers will carefully review the terms of your insurance policy, provide you with advice on whether their denial (or voiding of coverage) was wrongful, and if so, what the plan of action should be.
Navigate Your Appeal
In most cases, you can appeal your insurance denial through the appeal process established under your insurance policy. However, insurance companies typically have multi-level appeal processes that can extend for many months and often do not result in a favourable outcome.
Remember: acting quickly is crucial when dealing with your insurance denial. After you receive your denial, you have a limited amount of time to commence legal action under B.C. law. The appeal process can consume this valuable time, leaving you with a tight timeline to pursue legal action if your appeal is unsuccessful.
RHE Law: Experienced Vancouver Insurance Denial Lawyers
If you believe your insurance claim has been wrongfully denied, contact Rice Harbut Elliott LLP (RHE Law) as soon as possible. With decades of collective experience, our lawyers can explain your rights and legal options and help you receive what you are entitled to under your insurance policy. Call us today to schedule your free consultation.