Claiming a critical illness benefit
CI pays on diagnosis of a covered condition as the policy defines it. How to file, common denials, and how to respond.
The trigger
CI pays on diagnosis of a covered condition as the policy defines it, after the survival period (often 30 days). The medical definition — not the everyday meaning — controls.
File
Diagnosis documentation from the treating specialist matching the policy's exact definition, plus the claim form.
Common denials
- The condition doesn't meet the precise definition (e.g. an early-stage cancer excluded by wording).
- Diagnosis within a moratorium period.
- Misrepresentation on the application.
If denied
Ask which definition wasn't met and why; have your specialist address it directly; escalate insurer → OLHI → regulator. Size a CI need with the Critical Illness tool.
Need the letters?
Open the Fight-Back Kit templates →Educational only — not legal advice. Deadlines vary by province and are being confirmed with legal review; verify yours. For large or complex disputes, involve a lawyer early. Robert is a mascot, not an advisor.