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A GUIDE TO CRITICAL ILLNESS INSURANCE 22 What's your doctor's role in your claim process? When you approach your doctor for assistance with a critical illness claim, whether it be an individual plan or a group/association plan, you will need to provide the doctor with the specific claim forms from the insurance company. Each insurance company and policy may have unique forms for completion. The treating physician will be asked to complete the claim form, share test results, pathology reports and any other medical documentation as requested. There is often a fee for this service. Please note that your insurer is not responsible to pay the fee for completing forms. Your insurer may require additional medical information from hospitals, or other treatment specialists and these fees may be covered by the insurer. Your insurer will need to have your claim form, test results and other medical documentation submitted as soon as possible, to allow their claims assessor to review the claim and provide a decision. You can inform your doctor that the insurer's request is required for your claim to be processed to encourage speedy submission. The time it takes an insurance company to provide you with a claim decision is mostly dependent on the time it takes for your medical providers to respond to requests for information. You can help to speed up this process by completing all the necessary authorizations for retrieval of medical records. Your doctor will provide you with a medical diagnosis, however a doctor's diagnosis alone will not fulfil the eligibility requirements for a critical illness benefit payment. A critical illness policy requires that the condition or treatment be included within the coverage, that criteria such as waiting periods or survival periods are met, or that the diagnosis be of a certain severity before you can make a claim. Your doctor may not be aware of the contractual components of your critical illness policy, however definitions, exclusions and claim eligibility terms are explicitly provided for you in your policy booklet. Your agent can help you to understand the requirements for determining your eligibility and in submitting a claim. If you do not have an agent, your insurance company will help you navigate the claim eligibility process. Unlike disability insurance, your ability to work or earn an income isn't a factor for a critical illness claim. Your doctor does not need to indicate any restrictions or limitations to working or performing your job duties on a critical illness claim. MAKING A CRITICAL ILLNESS CLAIM