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Critical illness insurance is a specialized type of insurance that pays out if two things occur: first, you are diagnosed with an illness that is listed in the policy; and second, you survive for at least the time period specified in the policy.
Critical illness insurance can help ease financial burdens while recovering from a serious medical issue. Many professionals and other self employed people purchase an individual policy through an agent or broker. Some workplace group benefit plans also provide critical illness coverage.
Sometimes insurance companies refuse to pay out on legitimate critical illness claims. If that has happened to you or a loved one, it is important to consult with a critical illness insurance lawyer as soon as possible, as there are strict time limits that must be adhered to.
There are several reasons why an insurer might refuse to pay a claim.
The most common is when the diagnosis does not meet the policy definition.
Covered illnesses and diseases often include cancer, Parkinson’s, AIDS, Lou Gehrig’s Disease (ALS), heart attack, stroke, organ transplants, kidney failure, paralysis, and blindness. However, not all types and variations of these medical conditions will result in payment. The insurance policy will provide additional details for what is covered. For example, the policy might define heart attack as follows:
Heart attack (acute myocardial infarction) means a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of acute myocardial infarction, with at least one of the following:
The diagnosis of heart attack (acute myocardial infarction) must be made by a specialist. The insured person must survive for 30 days following the date of diagnosis.
No benefit will be payable under this condition for: elevated biochemical cardiac markers as a result of an intra arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty, in the absence of new Q waves, or ECG changes suggesting a prior myocardial infarction, which do not meet the heart attack definition as described above.
This definition is very technical, and contains an exclusion which is equally technical. Sometimes there is a genuine dispute in the medical evidence regarding whether the policy requirements are met.
Critical illness claims may also be denied if the insured person does not meet the survival period. In the heart attack example above, the survival period is 30 days. If death occurs within 30 days of the heart attack, the insurer is not required to pay.
Another common reason critical insurance claims are denied relates to the application process. If there was a failure to disclose part or all of your medical history, this could amount to a material misrepresentation, or in some cases an allegation of fraud. If the misrepresentation was not fraudulent, there are several legal arguments to challenge the denial.
If your critical illness claim has been denied, you have the right to dispute the denial. You also have the right to consult with a critical illness insurance lawyer, at no cost to you. Before consulting a lawyer, you should have the following ready:
Michael Jordan will then be able to provide you with a preliminary opinion. If Michael is of the opinion the insurance company may have gotten it wrong, most cases can proceed on a contingency fee basis; that is, a “no win, no fee” arrangement where the legal fees are a fixed percentage of the total recovery, usually 30%. Contingency fee retainer agreements are governed by the Law Society of Ontario.
To learn more, contact Michael Jordan, an insurance lawyer with more than 18 years experience resolving all types of insurance disputes, including denied critical illness insurance claims. He is a founding partner of the Bay Street litigation firm Jordan Honickman Barristers, serving clients across all of Ontario.
Michael Jordan is a honest, fair and intelligent lawyer! He is very patient and spends as much time as is needed to ensure his clients understand what he is doing. I would highly recommend him! Sandra Clarke
Michael Jordan is a man you want on your side! He is compassionate, caring and beyond knowledgeable! He will never steer you wrong! Michael Jordan has already made a huge impact on our family and will always be our go to guy!
Michael Jordan was my lawyer for my long term disability case. I would recommend using him for a LTD case. He was very knowledgeable, helpful and always available when I had questions.
Review for Mr. Michael Jordan, Long Term Disability Lawyer. I am not usually a person who leaves reviews, but on this occasion I felt compelled to given the exceptional service I have received. I was in a situation where I required urgent guidance regarding an LTD matter, I decided that I would find someone who had a very high google review...
I contacted Michael for my long term disability claim. My LTD had been denied and so I reached out to him for help. The process from beginning to end was perfect and simple. He really is there for any questions or concerns and is so kind and helpful. He makes you feel less alone and cares about your well being. With his help I was able to get a...
Patient and kind, thorough and knowledgeable, that's Mr Jordan.Im grateful to have made a connection such as this! Thank you.
Michael Jordan is a Wonderful Caring Understanding Professional man that truly helped me when my LTD was denied several times as most are. I knew many people give up but I was entitled to LTD. I called Michael and sent all of my information with all of my medical and he said I had a case. He will take a percentage only if he wins which he did...
Many LTD lawyers will give you advice that will be biased to their advantage. Michael is the only lawyer I spoke to who wants what’s best for you, and does not care if he benefits from your decisions. His advice is fair, he is honest, and I would not trust anyone else with my case. He will tell you what is best for you. I appreciate him so...
Michael Jordan will personally return your calls. He listens to you and provides excellent advise. I strongly recommend him.
Michael was very pleasant to deal with. I'm pleased with the work he did for me, always replied and understood my issue and supplied useful information. I highly recommend him.
My experience with Michael Jordan was excellent. I was given much needed advice and everything was explained to me in very clear terms. Response time was outstanding! Michael was reassuring and compassionate and was able to resolve my disability claim very successfully. I would highly recommend Michael and his team to anyone.
Mr. Jordan responded immediately to my first phone inquiry and has been readily available for detailed consultation and support throughout my long-term disability application. As the claim was finally approved and no litigation was required, there was no fee. Knowledgeable, professional and kind, there is no doubt that I will direct all my...
Michael Jordan is a wonderful lawyer. He is polite, very courteous and very professional. He answers his phone, responds to messages and takes the time to clearly explain the information that you need to know. He helped me out with an issue on little notice and was beyond helpful. If I could give him a higher rating than 5/5, I definitely...
I feel very fortunate to have come across Michael Jordan's practice. His responsiveness, sense of service, and professionalism inspired a lot of confidence in me to pursue my case. I highly recommend him to anyone who finds themselves in an overwhelming insurance process.
I recently had the pleasure doing business with Michael, he was very professional and did what he said he was going to do. Michael kept me updated through the entire process! I would highly recommend Michael's services and best of all I got the outcome I was expecting!
Very refreshing to have a lawyer actually pick up the phone himself. Gave me excellent advice free of charge regarding my LTD questions. Would highly recommend.
I would highly recommend Michael Jordan. From the very beginning, he was attentive, clear and precise with his direction, quick to respond and helped me through a very difficult time in my life. He assisted in making this process much smoother than I could have ever anticipated and I was very happy with the outcome. I would not hesitate for a...
Micheal Jordan is very knowledgeable and helpful in regards to long-term disability claims. Very willing to help by explaining and listening/understanding the problem. I would reccomend his services.
Thank you Michael, for your hard work. I like that if I needed anything your office was there to answer my question in a timely manner. You know your information and it was a great help on the case. Michael is respectful, hard work and knowledgeable gentleman that wants the best for he clients.
Thank you Michael and Your team for your...
LTD lawyer, Michael Jordan, jumped right on board to take my case, even though he did not have much time to prepare before the closing date of my case -due to my error. Also, Michael was right up front in our initial contact with his fees.
Due to the Covid-pandemic, we communicated through e-mails -including him taking correspondence...
Mr Jordan came into my disability fight with patience and kindness. He turned my situation around when I was being taken advantage of. He is very knowledgeable and knew exactly how to execute a plan to my benefit. He did exactly what he said he would do, and that is... Win! Thank you Michael Jordan. Much Appreciated!!
Great lawyer to represent you with legal matters. Michael answered the phone personally and listened to my initial concern. He then set up a meeting face to face (prior to COVID) and the rest was history. He is very professional and understanding. Michael was able to get me settlement and get the insurance company to pay.
I would strongly recommend Mike to represent you in a legal action. He is by far an excellent lawyer. Not only is he by far outstanding when it comes to the law but he knows how to handle your case from start to finish and win your case! He is the staple example of what a lawyer should be (has integrity, compassionate, honest, trustworthy,...
I strongly recommend Michael Jordan services as he displayed a high level of integrity. Michael proved to be responsive, knowledgeable, and professional with a high degree of emotional intelligence. My stress level was lessened with his attendance, support and knowledge of my case and situation. Retaining his services was the best thing I could...
Michael helped me with my STD and LTD case as my Insurance company denied all my applications from the beginning. His insight, dedication and professionalism has helped reach the agreement. I highly recommend him because whether it is your first time with a lawyer or not you will be treated like a known customer you will surely get help and...
Strongly recommend. Michael Jordan is professional, detailed and articulate. He can explain complicated issues and has the ability to translate them into a simple understandable terminology. My family was devastated when my LTD claim was denied. Michael defended my position and pursued the incident relentlessly. My very stressful situation...
Michael is one of the kindest and most caring lawyers. He was so patient with me and extremely attentive. Any time I had a question or concern, he would assure me that everything was going to be okay. During this difficult time as it is, he was able to continue with a mediation with ease and was able to have my case resolved to my utmost...
I was diagnosed with a chronic illness which made it impossible for me to do my daily responsibility of my workplace as well not including all my doctors and specialist appointments. I applied for my long-term disability that was provided by my workplace benefits. Unfortunately I was denied even with all the doctor's medical documents to...
When my family member was off of work and dealing with long term disability she went to Michael and was very pleased with his honesty, professionalism and candor. He worked hard and achieved a very positive result.
I am a lawyer and I have recommended Michael to many people because of the above-noted qualities.
Our client sustained serious injuries in a motor vehicle accident. She advanced claims against her insurance company for income replacement benefits, medical expenses, and cost of care. The claim settled for close to $2 Million dollars.
Our client was a successful business person. When his LTD claim was denied, he retained Michael Jordan who secured expert medical evidence that was instrumental in resolving the case.
Our client was unable to work due to debilitating depression and anxiety. The disability insurer denied the claim, but when faced with litigation, a settlement was achieved.
Our client was diagnosed with life threatening cancer, which resulted in a severe psychiatric response. The claim was denied based on an exclusion in the policy. The exclusion, however, was poorly drafted and the case quickly settled.
Brain fog, fatigue, and inability to focus and concentrate were the main symptoms. The insurer denied the claim due to lack of objective medical evidence, even though there was no requirement in the policy to provide objective medical evidence, and the nature of the impairments were inherently subjective. The case settled after litigation was commenced.
The claim was denied because our client was not participating in appropriate treatment, but his mistaken belief that he did not need treatment was a symptom of his disability. An expert psychiatrist was retained to provide opinion evidence that the failure to participate in treatment was a symptom of the underlying illness. The case quickly settled.
Our client had surgery to remove the tumour, but was left with severe chronic pain and anxiety. The case settled on favourable terms.
VERTIGO AND NAUSEA
The insurer did not believe our client’s self reported symptoms. During the litigation, extensive medical records and reports were obtained that supported disability and a fair settlement was achieved.
The claim was denied because there was no medical explanation for the sudden onset of chronic fatigue syndrome. Two expert reports were secured, and the case settled at mediation.
Our client suffered from severe anxiety that made work impossible. Despite this, her LTD claim was denied. It settled shortly after a lawsuit was commenced.
Our client was involved in a motor vehicle accident many years ago. He continued to suffer chronic pain, but the LTD insurer denied his claim. Expert opinion evidence helped secure the settlement.
The insurance company denied the claim after the two year “own occupation” test of disability changed to “any occupation”. Evidence was secured that the client could not work in any job, and the case resolved.
Previous results are not necessarily indicative of future results. Contact Michael Jordan, long term disability lawyer, for an assessment of your claim.
Jordan Honickman Barristers
Direct Cell: 416-460-6823