Legal Definitions - serious illness

Serious illness, in the context of insurance, refers to a medical condition or disorder that significantly and lastingly harms, or is highly likely to significantly and lastingly harm, the health of an individual who is either covered by an insurance policy or applying for one. This impairment is substantial enough to have a major, long-term impact on their overall well-being and ability to function.

• Example 1: Life Insurance Application

  Imagine Sarah is applying for a new life insurance policy. During the application process, she discloses that she was recently diagnosed with a severe, rapidly progressing neurological disorder. This condition is known to cause irreversible damage and significantly shorten life expectancy.

  How it illustrates the term: Sarah's neurological disorder is considered a serious illness because it is highly likely to permanently and materially impair her health, affecting her life expectancy and overall well-being in a profound and lasting way. An insurance company would factor this into their assessment of her risk.

• Example 2: Critical Illness Insurance Claim

  David has a critical illness insurance policy. He suffers a sudden, massive heart attack that leaves him with significant, permanent damage to his heart muscle, requiring ongoing intensive medical care and severely limiting his physical activity for the rest of his life.

  How it illustrates the term: David's heart attack and the resulting permanent heart damage constitute a serious illness. It has materially and permanently impaired his health and physical capabilities, triggering the benefits of his critical illness policy designed to cover such major health events.

• Example 3: Disability Insurance Assessment

  Maria, an architect, develops a chronic autoimmune disease that causes severe, debilitating joint pain and fatigue, making it impossible for her to work full-time or perform the intricate tasks required by her profession. Despite various treatments, her condition remains persistent and significantly limits her daily activities.

  How it illustrates the term: Maria's chronic autoimmune disease is a serious illness because it materially and permanently impairs her health and functional capacity, preventing her from engaging in her occupation. This would be a key factor in assessing her eligibility for long-term disability benefits.