Verification of the Critical Illness

The insurance company checks whether the diagnosed illness is covered under the terms of the policy. Common critical illnesses include cancer, heart attack, stroke, kidney failure, and organ transplants, but it depends on the specific policy.

A doctor or medical specialist may be consulted to verify the illness and its severity.

Review of Medical Records

The insurance company often requests detailed medical records from the policyholder’s healthcare providers. This could include lab results, doctor's notes, treatment plans, and other medical documentation that supports the claim.

Investigation of Pre-existing Conditions

Insurance companies may look into whether the illness was pre-existing before the policy was taken out. If the condition was known prior to the policy issuance or during the policy’s waiting period, it may affect the claim’s validity.

Independent Medical Examination (IME)

The insurance company may request the policyholder to undergo an Independent Medical Examination (IME), where a doctor hired by the insurer assesses the extent of the illness and determines if it meets the policy's criteria.