How To Deal With Denial of A Critical Illness Claim

An insurance policy for a critical illness should cover the policy holder in the event that he or she develops a serious and life-threatening illness. The denial of such coverage to an ill policy holder could frighten the person that has paid for the insurance and has then developed the terrible illness. A lawyer can work to do away with that fear, so long as all the facts have been straightened out.

Some of the most important facts

The policies that provide coverage to a person with a critical illness do not get sold to anyone with a pre-existing condition. By the same token, none of them can get affected by changes in the policy holder’s employment, or in the policy holder’s access to other sources of income. The amount that might be awarded the policy holder comes in the form of a lump sum.

In that respect, the insurance covering costs of a critical illness differs from long term disability coverage. The latter provides benefits in the form of scheduled payments. The coverage ends if the person being sent payments goes back to work. The ill person that has received a lump sum payment has relinquished all the coverage that his or her policy had offered previously.

What illnesses are covered under a policy that promises delivery of a lump sum of money?

Here are the illnesses that the insurance industry has chosen to call “critical.”

Cancer

Paralysis

Kidney failure

Heart attack

Alzheimer’s

Multiple sclerosis

Organ transplants

Stroke

Blindness

Note that certain life-threatening situations have not received mention. For example, if a patient were dependent on a device that served as substitute for an organ other than the kidneys or the heart, and if that same device malfunctioned, the affected patient might come close to dying. Fortunately, the denial of a claim does not eliminate the chance for an appeal.

The denied policy holder can appeal for a consideration. If the denied policy holder hired a lawyer, that same attorney would study the reasons the insurer could give for a denial.

Possible reasons for a denial

Illness is treatable

Lack of documentation

Illness must have been diagnosed by specialist in the appropriate field.

The attorney would get together with the patient and check to see if any of the possible reasons applied to the denial given the same patient. If the illness could be treated, then the lawyers would have trouble pushing for reconsideration of the insurer’s decision (denial). Yet that would not be the case if the other reasons applied.

If the original request had lacked documentation, the attorney could go after the required documents. If the diagnosis had to come from a specialist, the lawyer could seek out the proper specialist and arrange for his or her client to meet with that same expert. In that way, a Personal Injury Lawyer in Cambridge could work towards the goal of obtaining the desired reconsideration.