This is Part III of IV in our series on covered conditions of critical illness insurance in Canada. We’ll provide Standard definitions for the following 5 covered conditions along with some notes on each;
- Muscular Dystrophy
- Motor Neuron Disease
- Parkinsons Disease
- Aplastic Anemai
- 2 or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination;
- b) well-defined neurological abnormalities lasting more than 6 months, confirmed by MRI imaging of the nervous system, showing multiple lesions of demyelination;or
- c) a single attack, confirmed by repeated MRI imaging of the nervous system, which shows multiple lesions of demyelination which have developed at intervals at least 1 month apart.
Note that a simple diagnosis of muscular dystrophy is insufficient. While there are three possible ways that will qualify for a claim, all three require MRI confirmation of specific symptoms related to Muscular Dystrophy. A diagnosis of muscular dystrophy without an MRI test confirming one of those three variations will not qualify for a claim.
Motor Neuron Disease
- amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
- primary lateral sclerosis
- progressive spinal muscular atrophy
- progressive bulbar palsy or pseudo bulbar palsy, and limited to these conditions. The diagnosis of Motor Neuron disease must be made by a Specialist.
This covered condition appears to be unique out of all the conditions as it simply requires a definite diagnosis by a specialist without any further complications, definitions, qualifications, or tests.
Note again that being diagnosed with Alzheimer’s is insufficient for a claim. The insured must have ‘significant’ reduction in functioning AND require at least 8 hours of daily supervision. Since many contracts require notification of claim within 30 days of diagnosis, I’m left to question if the diagnosis must be made within 30 days of the insured also requiring 8 hours of supervision – if the insured’s health degrades over a period longer than 30 days, it seems like a claim may be denied.
Activities of Daily Living are:
- Bathing – the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment.
- Dressing – the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances.
- Toileting – the ability to get on and off the toilet and maintain personal hygiene.
- Bladder and Bowel Continence – the ability to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained.
- Transferring – the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment.
- Feeding – the ability to consume food or drink that already has been prepared and made available, with or without the use of adaptive utensils.
Exclusion: No benefit will be payable under this condition for all other types of Parkinsonism.
Quite a few points stick out with the definition. Note that there are varying types of Parkinsons, and only one specific type is covered. That type must include very clearly defined sypmtoms – if these symptoms are not present, no claim will be paid. And the insured must also not be able to do 2 of the activities of daily living. If they have other types of Parkinsons, no claim will be paid, If they miss only one of the activities of daily living, no claim will be paid. All of these conditions must be met simultaneously in order to meet the conditions required for a claim.
- marrow stimulating agents;
- immunosuppressive agents;
- bone marrow transplantation.
The diagnosis of Aplastic Anemia must be made by a Specialist.
Note that with Aplastic Anemia, there is a combination of 5 distinct items, all five of which must be met in order for a claim to be paid. You must have a definite diagnosis, the diagnosis must be confirmed by biopsy, the condition must result in one of the three symptoms noted, blood transfusion must be required, and you must be treated with one of the three treatments noted. If the insured’s condition and treatment fails even one of those conditions, then no claim will be paid.
Wrongful or criminal deception intended to result in financial or personal gain.