The specific illnesses that are considered "critical" and covered by a critical illness insurance policy can vary. Generally, critical illness insurance covers serious and potentially life-threatening illnesses such as cancer, heart attack, stroke, major organ transplant, and other conditions.
The specific illnesses and conditions covered by a critical illness policy will depend on the policy. Some policies may cover a wide range of illnesses, while others may be more limited in scope. It is important to carefully review the policy wording to understand which illnesses and conditions are covered.
In addition to the specific illnesses covered by the policy, there may also be other requirements that must be met in order for a claim to be paid. These requirements could include providing verification of the diagnosis from a qualified medical professional, meeting certain survival periods, and other conditions. It is important to understand these requirements and to carefully review the policy wording to ensure that you are aware of what is covered and what is not covered by the policy.
There are several reasons why a critical illness insurance claim might be denied. Some of the most common reasons for a claim denial include:
The policyholder did not meet the eligibility requirements for making a claim. This could include not having the required coverage in place at the time of diagnosis or not meeting the policy's requirements for making a claim.
The policyholder did not provide sufficient documentation to support the claim. This could include a lack of medical documentation or other required information.
The policyholder's illness or condition is not covered by the policy. It is important to carefully review the policy wording to understand which illnesses and conditions are covered.
The policy has exclusions or limitations that apply to the policyholder's illness or condition. It is important to carefully review the policy wording to understand any exclusions or limitations that may apply.
The policy has lapsed or been cancelled. In order for a critical illness policy to pay out, the policy must be in force at the time of diagnosis. If the policy has lapsed or been cancelled, the claim may be denied.
It is important to carefully review the appealing critical illness claim and the policy wording and to provide all required documentation in order to increase the chances of a successful critical illness claim. If a claim is denied, it is usually possible to appeal the decision.