Critical Illness Denied!

[Steve Meacher]

Help! My wife has colon cancer and her critical illness claim is being denied because she showed symptoms withing the 90 day period after signing the insurance contract. Here's the thing, the symptoms referred to are things that aren't necessarily symptoms of cancer. Constipation might be cancer or it might just be constipation. Aenemia might be cancer or it might be caused by the change of diet which was to have helped the constipation. It is only after the cancer was diagnosed that these other symptoms became ominous. Can they deny the claim by referring to these symptoms which are only symptoms of cancer because she has cancer? (If you can follow that) She never showed any symptom that was definately cancer (not even now). Can hindsight be used this way? Anyone know a good lawyer in Ontario?
(P.S. the insurance company is Clarica)

 

[cbg]

Steve, I'm sorry, but if you notice the red letters at the top of the page, this site deals only with US law. Canadian law is different, and Canadian insurance law is very different. Sorry we can't help.

 

[ALawyer]

Just some thoughts, apart from the fact that I am sorry about your wife's illness.

The usual test in the US is did the applicant for coverage lie -- make a material misstatement on the application, and if so the policy would not be honored. If a life insuranec company issued the policy and the person died the next day, say in an accident, the policy would be paid IF the applicant was honest and there was no fraud.

There are some policies I am familiar with in the US in which the benefits do not take effect on issue -- limited benefit life -- but only after 2 years, so if there is a death during the first 2 years no death benefit only a refund is paid.

In such cases it is necessary that the company make a clear disclosure that there is no coverage for 2 years.

Get an attorney in Ontario on this.