Why A Critical Illness Claim May Be Refused?

If you have a critical illness, you have good reason submit a claim and to seek the appropriate benefits. Of course the people charged with reviewing your claim will want proof of the fact that you do have a critical illness. Consequently, a denial of your claim seems to indicate that you have failed to satisfy at least one of the following conditions.

Presentation of confirmation of the diagnosis

It helps to obtain such a confirmation from a respected source, ideally from someone that specializes in the field related to your critical illness. See such a specialist and try to get confirmation of your diagnosis. Hopefully, you will walk away with a written document, one that supports the diagnosis that was given when you filed your claim.

Presentation of required documents

If a specialist has confirmed in writing that you suffer from the critical illness claimed in the request for benefits, then you should feel confident that you have satisfied this particular condition. If you cannot see a specialist, you might want to try getting X-rayed, or maybe obtaining a CT or an MRI scan. The results from those imaging sessions could be submitted, along with a note from an expert that has analyzed them.

Understanding the nature of a critical illness

If you do not understand the nature of a critical illness, then you may find that your illness has not been classed as one that has earned the status of “critical.” Maybe you felt it deserved that status because you heard that you needed surgery. That prognosis means that your condition is treatable. If a condition is treatable, it should not be classed as “critical.”
If you move forward with the surgery, you may be able to expose any effort on the part of the insurance to make light of true medical problems. If you are asked to see a doctor soon after surgery, honor that request. At that point, you are not likely to be ready for returning to work. If the insurance company’s doctor declares otherwise, you have good reason to question the motives of those that have previously denied your benefits.

Filing of necessary paperwork

When you filed you claim you had to present certain documents. Maybe you left some blank spaces in those documents. Perhaps you failed to include information on any pre-existing conditions. If you have none, then that should be stated clearly in the paperwork submitted at the time of the filing.

Payment of premiums in the past

When you file a critical illness claim, the people that review that file will look to see if you have paid the premium for earlier treatments. If you have not, then your claim will be denied. It is best to talk with your Injury Lawyer in Sarnia and get an evaluation done about your case.