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 a 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.
