Our blog will be featuring various entries concerning critical illness and disability claims. In order to help our readers, we have decided to dedicate a post to explaining a few definitions for critical illness insurance.
Critical illness insurance helps you to pay costs associated with life changing illnesses. Imagine you are in a situation where you aren’t able to work or pay your bills. These situations are usually unexpected.
What can critical illness insurance cover? Here is a list of many of the conditions:
- Alzheimer’s Disease
- Bacterial Meningitis
- Benign Brain Tumour
- Blindness
- Life Threatening Cancer
- Coma
- Coronary Artery Bypass Surgery
- Deafness
- Heart Attack
- Kidney Failure
- Loss of Limbs,
- Major Organ Failure/Major Organ Transplant
- Multiple Sclerosis/ALS
- Parkinson’s Disease
- Severe Burns
- Stroke
Even though this is a coverage you have purchased optionally, you have to meet specific criteria in order to ensure your claim is payable.
A Few Key Definitions:Â (these may vary depending on insurance companies)
Activities of Daily Living:
a) Bathing (with or without equipment)
b) Dressing
c) Toileting and maintaining personal hygiene
d) Bladder and Bowel Continence
e) Transferring (in and out of bed, from a chair, out of a wheelchair, with or without equipment)
f) Feeding (with or without equipment)
Independent Assessment:
This refers to independent medical examinations, investigations or tests conducted by specialists chosen by the insurance company in order to conform the diagnosis of the covered condition.
Satisfied the Criteria:
If the Insured Person has satisfied the criteria:
- has in all respects satisfied the definition of the applicable condition, received a diagnosis and where there are specific conditions to be met, satisfied those conditions;
- is not subject to an exclusion in the definition of the applicable condition;
- where required, attends independent assessments to confirm the diagnosis.
Survival Period:
This refers to the minimum number of consecutive days, after the date of diagnosis that the insurer person has to survive, depending on the condition they are claiming for. Other stipulations apply.
Payment of Policy Benefits:
Claims Reporting Requirements:
- An insured person has to submit a claim for critical illness within a certain number of days of the onset of the covered condition, many insurance companies dictate 120 days as the submission period;
- The forms are completed by the insured person and his or her physician;
- The insured person is responses for any expenses associated with proving the claim;
- Be prepared for the insurance company to request additional information.
Critical Illness Benefits Payable Upon Claim:
After your claim is submitted, the critical illness benefit amount is payable to the insured person once all the following conditions are satisfied:
- The insured is diagnosed with a condition that is covered through the critical illness policy.
- The criteria for the covered condition have been satisfied.
- The policy is in effect on the date of diagnosis of the covered condition.
- The insured survived the survival period/qualifying period as per the covered conditions.
- The insured has not suffered irreversible cessation of all functions of the brain (you cannot keep an insured person alive artificially for the purpose of claiming the benefit).
We hope that the above information has provided some clarity and insight into critical illness insurance.
Aaron Waxman & Associates assists clients with critical illness insurance claims. As is demonstrated above, specific criteria have to be met in order for a policy owner to receive benefits. When you are in need, our firm is here for you.
