Critical Illness Claim Help
Who needs critical illness claim help? Everyone who will file a claim. Critical illness insurance claims are much more complicated than many people realize.
People think that if they’ve been diagnosed with cancer or had a traumatic brain event they can file a critical illness claim and it will automatically be approved. This belief is wrong.
Every claim is individually evaluated by the insurance company’s claim examiner and subject to limitations, exclusions and deductions. Many policyholders don’t even know their policy has limitations and exclusions.
Critical illness claim help is our specialty. We prepare claims for our clients with the input of our medical team. Then we file the claim and work with the insurer’s claim examiners to get the maximum payout for our client. We’re the only firm in the US that prepares claims and fights the insurer during the claim examination process to get the best offer for our clients. Everyone else waits until a claim is denied.
Call us 1-888-428-4868 or Email Us for a free consultation.
There are two phases of a critical illness claim. The first phase is determining if a medical condition qualifies for benefits. The second phase is the calculation of the payout.
Limitations in Critical Illness Claims
Just because someone is diagnosed with cancer or has a cerebrovascular event, doesn’t mean their critical illness policy will pay a benefit. Policies have lists of what is covered. Limitations exist for conditions that aren’t covered and for conditions that are covered but still don’t qualify for a payout.
If the insured’s medical file doesn’t include at least one of the covered conditions their claim may be denied. Sometimes a person has a serious medical condition that causes pain, fatigue, incapacities and even death, but their doctors aren’t able to identify the exact cause right away. This is simply a fact of medical science. How that can play into a critical illness claim is that the insurer will deny a claim because, even though the symptoms of a covered claim are present, the insured’s doctor isn’t certain enough of the origin.
We don’t let that happen. Examiners are looking for reasons to deny claims. We look for reasons they have to be paid.
Exclusions in Critical Illness Claims
Exclusions can occur when a medical condition exists but the insurance company determines that it’s not dangerous enough. A common example is critical illness policies that only pay for a cancer diagnosis when the cancer is invasive. The challenge goes even further because the insurer likely has their own definition of what constitutes invasive cancer.
Critical Illness Claim Payouts
Once a critical illness claim is approved the next hurdle is getting the highest possible payout. Again, many people think every offer will be the highest. This is where it gets very complicated. Offers are based on a set of deductions that the insurer can take away from the maximum payout. So, a payout to one person diagnosed with leukemia may be very different than another person with the same diagnosis.
This is why we always recommend that we prepare and file the claims for our clients.
Many policies are ambiguous on how benefits are calculated. Most agents, who are the people promoting the policies, have no idea how benefits are calculated. The flyer or advertisement promoting critical illness coverage always give examples of people getting large payouts. But in reality payouts can be quite small and disappointing. And some claims are denied altogether. You have to know the language of the insurance industry to know how to fight back against low payouts. We do.
Completing the Critical Illness Claim Form
It’s well known that insurers don’t want to pay claims. Therefore, you need to have a claim presentation that is iron-clad and challenges the insurer at its own game. Simply checking a few boxes and getting a doctor’s statement on a critical illness claim form won’t be enough. Everyone filing a claim needs critical illness claim help.
The claim form itself gives no instruction on how to fortify your claim. It offers no critical illness claim help. The instructions simply give a one or two sentence directive and leave many questions unanswered. Insurers ask that the person filing the claim tell the insurer the condition they want to claim. That’s fine if it’s definitively known. But what about when it isn’t? Some medical conditions act like others and doctors don’t always have answers. That shouldn’t mean a claim isn’t payable. The underlying effect has to be evaluated and presented.
Evaluating a Critical Illness Claim Offer
Likewise, when a claim offer is made by the insurer it doesn’t come with full disclosure of how the offer was determined or calculated. There is room for negotiation on many offers but knowing the process, the terminology and the calculation basis is critical. Almost everyone is at a complete disadvantage for this part of critical illness phase two.
Help with Filing a Critical Illness Claim Gets Higher Payouts
You shouldn’t go into the filing of a critical illness claim without the representation of the Center for Life Insurance Disputes. Our trained experts will prepare your claim so it’s approved and we fight for the maximum possible payout.
In one recent filing in Miami we got the insurer to increase their payout offer by 30%. In another case in Washington DC, we got our client over $250,000.00 after the insurer denied her claim.
We’ve been handling claims for our clients for 30 years. Always representing the policyholder, never the insurer. Our clients never pay retainers.
If you need help with a critical illness claim contact us now by phone or email.
1-888-428-4868
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