A GUIDE TO CRITICAL ILLNESS INSURANCE
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What happens after the insurance company makes
their decision?
If your claim is approved: The insurance company will advise you of their decision and
arrange for payment.
If your claim is denied: The insurance company will advise you of their decision and
explain the reason for denying your claim.
What should you do if your insurance company denies your claim? Your policy lists the
specific conditions and criteria that need to be met to be eligible for a claim. It can be
confusing when your doctor diagnoses a condition that is listed under your contract, but
you are told that your claim is not payable. Your insurer will provide detailed information
explaining why your claim is not eligible. If you are using one, your agent can assist you in
explaining the terms of your coverage and in navigating the claims process. If you do not
have an agent, contact your insurance company for assistance.
There are circumstances that may slow down the process such as:
incomplete claim forms
your claim is within the contestability or pre-existing condition period
a delay in receiving information from doctors and other sources
a delay in receiving your authorization (when required) to collect additional medical
reports
if the insurance company needs to review possible inaccuracies made on your
application for insurance or claim forms
if any of the claim information requires translation services
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What to expect during the claim review process
Insurance companies are fulfilling their promise by paying eligible claims. Every claim is
given careful consideration. This involves reviewing the policy and eligible coverage to
confirm:
your coverage is in force
the accuracy of all the information provided on your application for coverage
that your condition matches the definition in the policy/coverage
that the exclusions and/or limitations in the policy/coverage are not applicable
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MAKING A CRITICAL
ILLNESS CLAIM
