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At Zayouna Law Firm, we really take the time and go the extra step to get personally acquainted with our clients and their situations.

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Critical Illness

What is critical illness insurance law?

Alzheimer’s, Parkinson’s, ALS, heart attacks, and strokes — these are just some of the most devastating, critical illnesses. Although Ontario covers healthcare, there is the persisting quality of life concerns. With lost income and rising living and care expenses, you need the support of a critical illness insurance policy.

What happens when your critical illness insurance claim is denied? Without the benefit of a critical illness insurance policy, your quality of life can quickly decline further. Even with public healthcare coverage for hospital treatments, you still have bills and other expenses to pay.

Zayouna Law Firm is here for you when critical illness insurance fails to protect you and your loved ones. Together, we fight for your rights, and ensure that you and your family are supported during this crucial, difficult period.

Why You Need a Critical Illness Insurance Lawyer

Challenges with Critical Illness Insurance Claims

You made the proactive choice to purchase a critical illness insurance policy. It’s a smart and responsible way to ensure financial security in the event of a critical diagnosis — or at least, it should have been.

Unfortunately, insurance companies are known to dispute or worse, deny otherwise valid critical illness claims. A denied claim prevents you from accessing the lump-sum benefit that a critical illness insurance policy is designed to provide, leaving you in a financially precarious situation as your living and treatment expenses rise.

Even when a claim is granted, many insurers are also known to delay or reduce payments, further impacting financial security and your ability to afford the cost of survival itself.

File a Critical Illness Insurance Lawsuit

Our critical illness lawyers can help you fight a denied insurance claim, and ensure that the policy benefits are paid out as promised. We represent you in a critical illness lawsuit against your insurance provider to seek the full benefits you should receive, as well as compensation for the added pain and suffering caused by a denied claim. 

A successful critical illness insurance lawsuit helps you access crucial financial resources for your survival and quality of life.

Eligibility for Critical Illness Insurance Claims

Benefits of Critical Illness Insurance

Critical illness insurance is a life insurance product that pays out a one-time lump-sum payment if you are diagnosed with a critical illness. Commonly covered illnesses include:

  • Heart attack
  • Stroke
  • Alzheimer’s
  • Parkinson’s
  • HIV-AIDS
  • ALS
  • Cancer
  • Paralysis
  • Organ transplant
  • Blindness, and more.

This one-time benefit payment can provide financial security. It can be used for living expenses, such as rent or mortgage, groceries, and other necessities, as well as treatments not covered by public healthcare, attendant care, and medical devices. This financial resource is especially crucial if you cannot work while undergoing treatment, or your condition continues to deteriorate.

Key Facts About Critical Illness Insurance Benefits

A diagnosis is just the first step to qualifying for critical illness insurance benefits. Check your policy to confirm the terms and conditions you need to keep in mind for a successful claim:

  • Diagnosis: A diagnosis for specific illnesses covered must be confirmed by a qualified physician
  • Survival: You must pass a survival period, typically 30 days after the diagnosis is confirmed before the benefit amount is paid out
  • Lump-sum benefit: You can only make one claim, and coverage terminates once the lump-sum benefit is paid out
  • Medical underwriting: The policy is medically underwritten, meaning your medical history will be examined for pre-existing conditions
  • Difference from long-term disability: A critical illness benefit is not an offset or income replacement benefit, and therefore does not reduce the amount of long-term benefits you are entitled to.

Our Critical Illness Insurance Lawsuit Process

At Zayouna Law Firm, we understand the physical, mental, emotional, and financial toll a critical illness takes, and we’re here to support you through it. Our critical illness lawyers are here for you when your insurance policy fails to support you. We are dedicated to fighting for your rights and claiming the benefits you need to navigate this difficult time.

  1. Consultation: Book a free consultation to discuss your critical illness diagnosis and denied insurance claim. We can advise you of your legal options to claim your benefits.
  1. File a critical illness insurance lawsuit: We represent you in legal proceedings against your insurance provider. Our critical illness lawyers work with medical experts and insurance professionals to present exhaustive evidence that proves your need for critical illness insurance benefits and the validity of your claim.
  1. Resolution: Outside the courtroom, we advocate for your immediate needs and care by connecting you with treatment specialists to aid in your recovery. With our contingent fees, we only charge when we win.

Experienced Critical Illness Insurance Lawyers

Zayouna Law Firm is your critical illness insurance lawyer. Our entire legal team is here for you at every step of the lawsuit, from consultation and representation, to benefit payout and your improved quality of life. Our vast legal expertise in critical illness insurance law allows us to build a strong claim in your best interest, and tirelessly advocate for your rights.

  • Results: Your best outcome is our success. We have successfully represented countless critical illness insurance claims and recovered benefits for clients and families. We stop at nothing to recover your rightful benefits, and ensure your long-term health and well-being.
  • Relationships: We value relationships. More than our memberships in the Ontario Trial Lawyers Association and the Ontario Bar Association, we care most about our relationship with you. Our commitment is constant communication and your full participation throughout the legal process.
  • Recovery: Our mission is your recovery — your rightful critical illness benefits, increased access to life-saving treatments, and improved quality of life. We fight for you in and out of the courtroom, ensuring you are fully supported during this critical period, so you and your family can focus on getting better and stronger.

FAQs About Critical Illness Insurance Lawsuits

If your claim was denied for any reason, continue seeking treatment and have your condition documented to show continuous disability. In the meantime, speak with a critical illness lawyer to obtain legal advice. They can interpret the denial letter and advise you of your legal options to commence a lawsuit for claiming your benefits.

There are a number of reasons as to why your claim was denied. Insurers commonly cite lack of medical evidence and/or missed submission deadlines, a diagnosis not covered in the policy, or receiving what they deem is inappropriate treatment administered by an inappropriate physician or specialist.

Each insurance claim is unique. The allowable period for commencing legal action usually depends on when the denial occurred, when the policy was entered into and whether it had been renewed. Generally, you have two years to commence legal action and file a claim for denied critical illness insurance benefits. For best results, contact a critical illness lawyer right away to obtain legal advice and ensure you meet filing deadlines.

Both insurance policies provide financial resources in the event of a severe illness. Their main difference is the benefit amount and how it is paid out. Long-term disability is designed to provide monthly income replacement, while critical illness insurance pays out a one-time lump sum benefit, upon which coverage terminates.

Long-term disability covers a broader range of diagnoses that meet the policy’s definition for total disability. These include both injuries and impairments from accidents, and illnesses. As its name implies, critical illness insurance only covers specified major illnesses. While long-term disability benefits can be offset or reduced by other benefits (i.e. CPP or WSIB), critical illness pays out the lump sum you are insured for.

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