Life Insurance Lawyer Naperville Illinois

Critical illness insurance claims can be denied for various reasons, including the failure of the applicant to disclose crucial information during the application process. This omission may involve concealing pre-existing medical conditions or engagement in hazardous occupations. Additionally, denials can occur if the diagnosed illness or medical condition falls outside the coverage scope outlined in the policy or fails to meet the defined criteria for a critical illness. Some policies mandate a survival period post-diagnosis, and if this requirement isn't met, the claim might be rejected. Similarly, if the policyholder passes away before the specified waiting period concludes, the claim may not be honored.

Policy lapses due to non-payment of premiums or cancellation, or the policy not being in force at the time of diagnosis or death, are also grounds for claim denial. Claims could be denied if the insured's death is attributed to suicide, illegal activities, or engaging in high-risk activities not covered by the policy. Furthermore, fraudulent or criminal activities related to the policy or claim, such as misrepresentation during the contestability period, can lead to denial. If the policyholder fails to comply with the terms and conditions, including necessary treatments or providing adequate medical records, the claim might be rejected. Claims related to pre-existing conditions excluded from coverage or death from specific causes excluded by the policy, like war or terrorism, can also be denied. Thus, adherence to policy terms and accurate disclosure of health information are crucial to avoid claim denials.