This is Part V of VII discussing standard definitions of covered conditions for critical illness insurance.
A definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the Insured Person’s normal occupation, which exposed the person to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred after the later of the effective date of the policy, or the effective date of last reinstatement of the policy.
Payment under this condition requires satisfaction of all of the following:
- The accidental injury must be reported to the insurer within 14 days of the accidental injury;
- A serum HIV test must be taken within 14 days of the accidental injury and the result must be negative;
- A serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
- All HIV tests must be performed by a duly licensed laboratory in Canada or the United States of America;
- The accidental injury must have been reported, investigated and documented in accordance with current Canadian or United States of America workplace guidelines.
The diagnosis of Occupational HIV Infection must be made by a Specialist.
Exclusion: No benefit will be payable under this condition if:
- The Insured Person has elected not to take any available licensed vaccine offering protection against HIV; or,
- A licensed cure for HIV infection has become available prior to the accidental injury; or,
- HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use.
For those where contracting HIV at the workplace is an issue, pay close attention to the sequence of events required to have a successful claim. Not only must specific tests be completed, but they must be completed within a very tight and specific timeframe. You must take a test within 14 days of the accident, and another test within 90 to 180 days of the accident. And it must be investigated within the guidelines of Canada or the US workplace guidelines.
Additionally, while not part of the standard wording, some companies require that the accident take place only in Canada or the U.S. Accidents that happen outside of those two countries would not be a covered condition under the policies of those companies. Please note that these companies will be marked as having non-standard definitions in our online critical illness quotes.
Exclusion: No benefit will be payable under this condition for viral meningitis.
This may be one of the clearer definitions in that the conditions appear to be relatively straighforward – but like all these conditions it pays to look close. You must take a specific type of test. However the condition must also result in documented neurological deficit for at least 90 days. Without that condition being met, a claim would not be paid.
Complications from Infectious Diseases
This covered condition is not a standard part of most critical illness insurance contracts in Canada so we have not included it as part of the list Most companies do not cover this. However for those that do, the coverage is typically for E. Coli, Flesh Eating Disease, West Nile Virus, and Lyme Disease. Like all covered conditions, developing the diseases is insufficient. Instead speciific test must happen and clearly defined symptoms must occur. These vary by each of the four diseases. You are advised to review your specific contract for wording on this covered condition.
Wrongful or criminal deception intended to result in financial or personal gain.