Definitions

The following definitions are provided by The Empire Financial Group
They are intended for guideline purposes only as Critical Illness definitions may vary for different insurance companies and not all companies insure all conditions.

Heart Attack
The Diagnosis by a Doctor of the death of a portion of the heart muscle, resulting from blockage of one or more coronary arteries. The Diagnosis must be based on both:

a:) new electrocardiograph (ECG) changes, which support the Diagnosis of heart attack, and
b:) elevation of cardiac (heart) enzymes.

Explanation
When a heart attack occurs, part of the heart muscle dies because there is a shortage of blood to the heart. To confirm the diagnosis of heart attack the ECG is reviewed to see if there is evidence of heart damage (new ECG changes). In addition, blood tests are run to detect the incidence of a heart attack (elevation of cardiac enzymes).

Stroke or Cerebrovascular Accident (CVA)
The Diagnosis by a Doctor of a cerebrovascular incident causing infarction of brain tissue. A stroke may be caused by hemorrhage (bleeding into the brain), thrombosis (blood clotting in a brain artery) or embolism (usually a clot elsewhere in the body) and can result in a measurable neurological deficit such as paralysis to some part of the body or speech and/or vision impairment. The resulting impairment must last thirty (30) days following the stroke. Transient Ischemic Attacks (TIAs), mini strokes that cause no permanent damage, are not covered.

Explanation
Stroke or Cerebrovascular Accident (CVA) occurs when blood supply to the brain is reduced sufficiently, causing permanent neurological damage. The resulting damage must last at least 30 days following the stroke.

Life Threatening Cancer
The Diagnosis by a Doctor of a malignancy characterized by the uncontrolled growth and spread of malignant cells and the invasion of healthy tissue. Some cancers are less serious and therefore, not considered “life threatening” for purposes of Critical Illness coverage.

The following forms of cancer are excluded from coverage under this Insured Condition definition:
a:) Early prostate cancer (Stage A), diagnosed at T1N0M0 or equivalent staging;
b:) Non-invasive cancer in situ;
c:) Pre-malignant lesion, benign tumors or polyps;
d:) Any skin cancer other than invasive malignant melanoma into the dermis or deeper;
e:) Any tumor in the presence of any Human Immunodeficiency Virus (HIV).

There shall be no Critical Illness coverage if within ninety (90) days following the effective date or, if applicable, the last reinstatement date, of this Critical Illness protection,
a:) A Diagnosis of cancer is made, or
b:) Any Symptoms or medical problems commence and initiated investigations lead to the Diagnosis of any cancer.

** Note: Excluded Cancer conditions will vary by Insurance Company.

Explanation
A cancer is a type of abnormal cell growth that spreads throughout the body, destroying healthy tissue. Some cancers are less serious and therefore not considered “life threatening” for purposes of Critical Illness coverage. Those tumors are shown on the list above.
If one of the listed excluded cancers is not cured but, worsens and is diagnosed as another classification, benefits do become payable. For instance, although Stage A prostate cancer (early stage and hardly detectable) is not covered, if it worsens to an advanced stage prostate cancer, it becomes eligible under this policy.
If the cancer is diagnosed within ninety (90) days of the effective date, or the last reinstatement date of those Critical Illness provisions, no benefits will be paid under the policy.

Renal Failure
The Diagnosis by a Doctor of irreversible failure of both kidneys, which necessitates:

a:) regular treatment by peritoneal dialysis or hemodialysis or
b:) a kidney transplant.

Explanation
Both kidneys no longer function and the insured must have dialysis using a machine that replaces the kidney function on a regular basis or receive a kidney by transplant.

Paralysis
Paralysis shall mean Diagnosis of the complete and permanent loss of the use of two or more limbs through paralysis for a continuous period of ninety (90) days or more, confirmed by a Physician.

Explanation
Coverage is intended for a Person Insured who experiences complete and permanent loss of sensation and voluntary movement in at least two limbs lasting continuously for more than 90 days. The 90-day restriction is necessary as paralysis can often last for a short period of time with subsequent full recovery.

Coronary Artery Disease/Surgery
This insured condition shall mean heart surgery performed on the recommendation of a Cardiologist licensed and practicing in Canada, to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. Only coronary artery bypass surgery is covered in this insured condition as it results in a significant recovery period. The following techniques are excluded from coverage under these provisions:

a:) any non-surgical techniques including, but not limited to, balloon angioplasty and laser embolectomy and
b:) any other non-bypass techniques.

Explanation
If one or more arteries going to the heart become blocked, surgery can be performed to bypass the blockage by substituting a vein or an artery from elsewhere in the body. This type of surgery is major and results in a significant recovery period. Other procedures for improving blood flow to the heart such as balloon angioplasty and other excluded techniques are less traumatic than bypass surgery and therefore, not covered.

Vital Organ Failure/Transplant Failure
The insured condition shall mean the irreversible failure of the heart, liver, bone marrow, both lungs, or both kidneys, requiring receipt of a transplant of that organ or tissue. The Person Insured must be accepted into a recognized transplant program in Canada and must survive at least thirty (30) days following the date of enrollment into the transplant program. Note that this differs from the coverage for the actual transplant surgery itself. Payment would be made under either condition, but not both.

Explanation
Coverage is intended for a Person Insured who is “on the transplant list”. This differs from the coverage for the actual transplant surgery itself. Payment would be made under either conditions, but not both.

Transplant
The insured condition shall mean the undergoing of surgery as a transplant recipient of any of the following organs or tissues: heart, liver, bone marrow, lung or kidney. Benefits become payable after the Person Insured survives thirty (30) days after the transplant surgery.

Explanation
Any one of the above named organs can become injured or diseased sufficiently as to require that the insured receive a new organ via transplant. After the new organ has been transplanted into the insured’s body and the insured survives 30 days, benefits become payable.

**Note: This definition has been provided by Empire Financial Group. Other insurance companies may provide this coverage of failure and transplant under one definition.

Multiple Sclerosis
Multiple Sclerosis shall mean the unequivocal Diagnosis by a Physician certified as a neurologist of well-defined neurological abnormalities lasting for a continuous period of at least six (6) months, and confirmed by modern investigative techniques such as image scanning. Neurological abnormalities in this context must be evidenced by the typical symptoms of demyelination with resultant impairment of the brain stem or spinal cord, but the Person Insured need not be confined to a wheelchair.

Blindness
The Diagnosis by an Ophthalmologist, licencing and practicing in Canada, of permanent loss of sight in both eyes, with the corrected visual acuity being less than 20/200 or the field of vision less than twenty (20) degrees in both eyes.

Explanation
The 20/200 stipulation avoids a situation where the Person Insured is “legally blind”, but not considered totally blind.

Deafness
The Diagnosis by an Otolaryngologist, licensed and practicing in Canada, of permanent loss of hearing in both ears, with auditory threshold of more than ninety (90) decibels in each ear. The Person Insured will not be covered for temporary deafness.

Explanation
Temporary deafness is a more common occurrence than permanent deafness and can arise from injury or infection. In order to provide coverage only for permanent deafness in both ears, it is necessary to stipulate the type of medical practitioner who made the diagnosis and the level of deafness that is considered acceptable for payment of the benefits.

Loss of Speech
The Diagnosis by a Doctor who is certified in a medically appropriate specialty and licensed and practicing in Canada, of the total, permanent and irreversible loss of the ability to speak due to physical injury or physical disease. The loss of speech must persist for at least one hundred eighty (180) days.

Explanation
Temporary loss of speech is more common than permanent loss of speech and can result from a simple sore throat. For this reason there are stipulations regarding the type of medical practitioner and the length of time the insured is unable to speak.

Alzheimer Disease
The Diagnosis by a certified Neurologist, licensed and practicing in Canada, of Alzheimer Disease. The Person Insured must exhibit the loss of intellectual capacity involving impairment of memory and judgement, which results in a significant reduction in mental and social functioning, such that the Person Insured requires personal supervision for daily living. All other dementing organic brain disorders by other brain diseases, psychiatric illnesses, or substance abuse are excluded.

Explanation
This disease is difficult to diagnose, therefore the wording is specifically related to behaviour and symptoms. Note that a specialist in the area of Alzheimer Disease must diagnose the illness.

Parkinson’s Disease
The Diagnosis by a certified Neurologist, licensed and practicing in Canada, of primary idiopathic Parkinson’s Disease, which is characterized by the clinical manifestation of two or more of the following symptoms:

a:) muscle rigidity,
b:) tremor, or
c:) bradykinesis (abnormal slowness of movement; sluggishness of physical and mental responses). All other types of Parkinsonism are excluded.

Explanation
Note that a specialist in the area of Parkinson’s Disease must diagnose the illness due to the difficulty in
accurately diagnosing this condition.

Coma
The Diagnosis by a Neurologist, licensed and practicing in Canada, of a Person Insured’s state of unconsciousness, exhibiting no reaction to external stimuli and persisting continuously with the use of life support systems for a period of at least ninety-six (96) hours.

Explanation
A person can be in a coma for a short period of time and can make a full recovery with no permanent damage. For this reason there is a stipulation that the coma must last for at least 96 hours continuously and the insured must require life support systems during that time.

Severe Burns
The Diagnosis by a Plastic Surgeon, licensed and practicing in Canada, of third degree burns covering at least 20% of the surface area of the Person Insured’s body.

Explanation
Third degree burns are the most serious type of burns and the 20% requirement ensures that the burn can be considered “life threatening”.

Dismemberment (Loss of Limb)
Loss of Limbs shall mean Diagnosis of the complete and permanent loss of the use of two or more limbs through dismemberment confirmed by a physician.

Explanation
The limbs must be severed with permanent loss of use.

Motor Neuron Disease (ALS or Lou Gehrig’s)
Motor Neuron Disease shall mean the unequivocal diagnosis by a certified neurologist, licensed and practicing medicine in Canada, of one of the following:

a:) Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease);
b:) Primary Lateral Sclerosis;
c:) Progressive Spinal Muscular Atrophy;
d:) Progressive Bulbar Palsy; or
e:) Pseudo Bulbar Palsy.

Other variations of Motor Neuron Disease are not covered.

Benign Brain Tumour

Benign Brain Tumour shall mean a benign (non-cancerous) tumour within the substance of the brain. Cysts, granulomas, meningiomas, malformations of the intracranial arteries or veins, or tumours of the cranial nerves, pituitary gland or spinal cord are excluded from coverage.

Occupational Human Immunodeficiency Virus Infection

The Diagnosis of Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the Person Insured’s normal occupation, which exposed the person to HIV contaminated blood or body fluids.

Payments under this Insured Condition requires satisfaction of all of the following:

a:) the accidental injury must be reported to the insurer within fourteen (14) days of the accidental injury;
b:) an HIV test must be taken within fourteen (14) days of the accidental injury and the result must be negative;
c:) an HIV test must be taken between ninety (90) days and one hundred eighty (180) days after the accidental injury and the result must be positive;
d:) all HIV tests must be performed by facilities approved by the insurer;
e:) the Person Insured’s normal occupation is regulated by Canadian workplace regulation; and
f:) the accidental injury must have been reported, investigated and documented in accordance with workplace legislation and regulations.

No payment will be made if:

a:) the Person Insured has elected not to take any available licensed vaccine offering protection against HIV;
b:) a licensed cure for HIV infection has become available prior to the accidental injury; or
c:) HIV infection has occurred as a result of a non-accidental injury (including, but not limited to, sexual transmission or intravenous [iv] drug use).

Explanation
There are very specific conditions for coverage to ensure the HIV was contracted as a result of occupational exposure.

Loss of Independence
Loss of Independence means the Diagnosis of an irreversible permanent disability caused by ageing, illness, or injury which prevents the Life Insured from performing three out of five activities of daily living as listed below without requiring the assistance of another person;

a:) Dressing – the putting on and taking off of necessary items of clothing
b:) Mobility – the ability to move from one room to another, or getting in and out of a bed or chair
c:) Eating and Drinking – the ability to consume food and drink which has been prepared and made available
d:) Toileting – the ability to get to and from the toilet, to get on and off the toilet and to maintain personal hygiene
e:) Continence – the ability to voluntarily control bowel and bladder functions.