Critical Life Insurance – What Do the Terms Mean?

When one says a man has a heart attack, we all know what that means.  When we hear that a middle-aged woman dies of cancer, we don’t ask a lot of questions; we know what cancer generally entails.  Unfortunately, the same thing does not apply when this man or the family of the woman files a critical life insurance claim.  Insurance companies ask a lot of questions.  A heart attack isn’t just a man collapsing and cancer is never just a case of deadly cells when you are dealing with insurance providers.

Claims assessment is typically based on the diagnosis of a professional medical practitioner.  Thus, it is crucial that both the insurer and the insured agree on the definition of each type of critical illness covered.

Definition of Terms

1.  Cancer – By definition, cancer is any malignant tumor which is caused by an uncontrolled cell growth and multiplication.  These cells spread throughout other body parts and, if not controlled or stopped, they may eventually lead to death.  Examples include Hodgkin disease and leukemia.

2.  Heart Attack – This results in serious heart muscle damage.  Changes in ECG and elevation of heart enzymes are a few of the symptoms of a heart attack.  In critical illness insurance, the discovery of changes in ECG that suggests an earlier silent heart attack is not covered.

3.  Stroke – This covers all three causes of stroke such as thrombosis, embolization and hemorrhage.  The first two involve a blockage of the artery in the brain while the latter involves a rupture of the blood vessel near or on the brain’s surface.  The occurrence of any of these three is not covered if the condition does not last for at least 24 hours; in such cases, the stroke is not considered as a critical illness but a transient ischemic attack.

4.  Coronary Bypass – A heart surgery aimed at correcting the blockage or narrowing of one or more arteries through bypass grafts is typically covered by critical life insurance policies.

5.  Multiple Sclerosis – This is a neurological abnormality evidenced by demyelization and impairment or the spinal cord or brain stem.  This illness, whether acute, chronic or benign, is usually covered.

6.  Kidney Failure – This is the term for the last stage of renal disease.  At this stage, the patient has to undergo regular dialysis or a renal transplant.  This is usually covered in a regular critical illness insurance policy.

7.  Occupational HIV Injury – HIV is considered to be a critical illness, but not all policyholders diagnosed with HIV can make a claim.  Critical life insurance policies typically cover only accidental injury; thus, the policyholder shouldn’t have acquired the disease through sexual activities and recreational drug use.  Furthermore, no payment will be made to the insured if he refused to take any licensed vaccine to guard himself against the virus or when a licensed cure has already become accessible prior to his accidental injury.  For a claim to be approved the injury (e.g. accidental HIV-infected needle injection) should have been reported to the insurance company within 14 days of the accident and the tests must have been done by the company’s accredited facilities.  Workplace guidelines are also taken into consideration when evaluating the validity of a claim.

Other Critical Illnesses

Major organ transplants, blindness or permanent loss of eyesight, deafness or total, profound and permanent loss of hearing in both ears with an auditory threshold of more than 90 decibels, paralysis, Alzheimer’s disease, and Parkinson’s disease are also valid causes for claims as long as the necessary requirements are met.

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