Critical Illness

Critical Illness for Members

If, while coverage is in effect, you, for the first time in their lifetime are Medically Diagnosed with Life Threatening Cancer, Aplastic Anemia, Bacterial Meningitis, Loss of Independent Existence, Loss of Limbs, Loss of Speech, Paralysis, Occupational HIV, Multiple Sclerosis, Motor Neuron Disease, Alzheimer’s Disease, Parkinson’s Disease or a Benign Brain Tumour, or suffers a Heart Attack (Myocardial Infarction), Stroke, Kidney Failure, Coma, Deafness, Burns, or Major Organ Failure, or becomes Blind, or undergoes Aortic Surgery, Coronary Artery Bypass Surgery, Heart Valve Replacement or a Major Organ Transplant or a Partial Benefit condition (meaning Coronary Angioplasty, Chronic Lymphoma Leukemia (CLL), Carcinoma in situ of breast, Malignant Melanoma, Prostate Cancer or Thyroid Cancer), and you survive the Survival Period, Co-operators Life will pay to you the amount indicated in the Schedule of Benefits, provided the following conditions have been satisfied:

  • you have satisfied the criteria of a Critical Illness described under the Covered Conditions – Critical Illnesses;
  • you have been diagnosed with a Critical Illness prior to the termination age of the Critical Illness benefit as indicated in the Schedule of Benefits;
  • the Date of Diagnosis must occur after your coverage under the Critical Illness benefit becomes effective and prior to the date the Policy terminates or the date your coverage under this benefit terminates;
  • you are receiving and following Reasonable and Customary Treatment;
  • you survive for the Survival Period and have not experienced irreversible cessation of all functions of the brain; and
  • if your condition is Medically Diagnosed or treated outside of Canada, the benefit will be payable only if all of the following conditions are satisfied:
    • the complete medical records are made available to Co-operators Life promptly, and
    • based on these medical records, Co-operators Life is satisfied that:
      • the same Diagnosis would have been made if the Covered Condition had been Medically Diagnosed in Canada;
      • the same treatment, involving the particular surgical procedure, would have been advised if treatment had taken place in Canada;
      • the Physician or Specialist making the Diagnosis was licensed to practice in the jurisdiction in which the Diagnosis was made and had medical credentials at least equal to those required in Canada; and
  • if requested by Co-operators Life you must undergo an Independent Medical Examination by a Physician or Specialist appointed by Co-operators Life.

Upon payment under the Partial Benefit, the insurance will remain in effect and the Amount of Insurance will not be reduced by the Partial Benefit payment. Only one Partial Benefit claim will be paid under this provision.

Once a full Critical Illness benefit is paid, coverage will terminate and no further insurance is available for you under this Provision unless the Multiple Event Benefit is indicated as covered in the Schedule of Benefits.

Critical Illness Definitions

“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 assistive devices;
  • dressing – the ability to put on and remove necessary clothing, braces, artificial limbs or other surgical appliances with or without the aid of assistive devices;
  • toileting – the ability to get on and off the toilet and maintain personal hygiene with or without the aid of assistive devices;
  • 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 aid of assistive devices; and
  • feeding – the ability to consume food and drink that has already been prepared and made available, with or without the use of assistive devices.

“Brain Death” means an irreversible form of unconsciousness (irreversible coma) characterized by a complete loss of brain function while the heart continues to beat. The usual clinical criteria for brain death include the absence of reflex activity, movements, and respiration. Pupils should be dilated and fixed.

“Critical Illness” means any of the Covered Conditions listed under Covered Conditions – Critical Illnesses.

“Date of Diagnosis” is the date the Critical Illness is first Diagnosed by a Physician or Specialist, unless otherwise specified under Covered Conditions – Critical Illnesses and subject to verification by an Independent Assessment, at the sole discretion of Co-operators Life.

“Diagnosis or Diagnosed” means the complete fulfillment of the definition of a Covered Condition specified under Covered Conditions – Critical Illnesses.

“Independent Assessment” means independent medical examinations, assessments or tests performed by one or more Physicians/Specialists as selected by Co-operators Life to confirm the Diagnosis of a Covered Condition.

“Life Support” means you are under the regular care of a Specialist for nutritional, respiratory or cardiovascular support when irreversible cessation of all functions of the brain, as confirmed by electroencephalogram (EEG) studies, has occurred.

“Medically Diagnosed Condition” or “Medically Diagnosed” shall mean a Sickness or an Injury which has been diagnosed according to a generally accepted classification system including but not limited to an x-ray, magnetic resonance imaging (MRI), bone scan, biopsy, x-ray computed tomography scan (CAT scan), psychometric testing including Minnesota multiphasic personality inventory-2 (MMPI-2), or a haematological or ultrasonic test.

“Physician” is a person who is legally licensed to practice medicine in the Province or Territory where the service is rendered and registered by the College of Physicians and Surgeons in the Province or Territory in which the person is practicing. A Physician does not include someone who is related to you.

“Reasonable and Customary Treatment” means systematic medical treatment that is:

  • generally accepted and recognized by the Canadian medical profession as effective, appropriate, and essential in the treatment of the Medically Diagnosed Condition, and
  • of a nature, intensity, frequency, and duration essential to the diagnosis or management of the Medically Diagnosed Condition involved; and
  • prescribed and rendered by a Physician or where considered appropriate by Co-operators Life, prescribed and rendered by a Specialist.

“Surgery” is the treatment of disorders of the body by incision or manipulation with surgical instruments.

“Survival Period” is the period starting on the Date of Diagnosis of the Critical Illness and ending 30 consecutive days immediately following the Date of Diagnosis of the Critical Illness, except where a longer period of time is provided specifically under Covered Conditions – Critical Illnesses, in which case, the number of days specified will apply. The Survival Period does not include the number of days you are on Life Support. You must be alive at the end of the Survival Period and must not have experienced irreversible cessation of all functions of the brain.

“Specialist” means a licensed medical practitioner who has been trained and specializes in a particular study or work and is registered by the College of Physicians and Surgeons in the Province or Territory in which the person is practicing and has been recognized with a designation in the area of speciality which is relevant to the Covered Critical Illness condition for which a benefit is being claimed. A Specialist does not include someone who is related to you. In the absence or unavailability of a Specialist, and only where approved by Co-operators Life, a condition may be Diagnosed by a qualified Physician. Specialist includes, but is not limited to; cardiologist, neurologist, nephrologists, oncologist, ophthalmologist, and burn specialist.

“Independent Medical Assessment” is a condition precedent to the payment of a Critical Illness Benefit that you shall, if required by Co-operators Life, undergo an Independent Assessment, by one or more Physicians/Specialists chosen by Co-operators Life.

Covered Conditions – Critical Illnesses

Alzheimer’s Disease – Dementia, including Alzheimer’s Disease is defined as a definite Diagnosis of dementia, which must be characterized by a progressive deterioration of memory and at least one of the following areas of cognitive function:

  • aphasia (a disorder of speech);
  • apraxia (difficulty performing familiar tasks);
  • agnosia (difficulty recognizing objects); or
  • disturbance in executive functioning (e.g. inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behaviour), which is affecting daily life.

You must exhibit:

  • dementia of at least moderate severity, which must be evidenced by a Mini Mental State Exam of 20/30 or less, or equivalent score on another generally medically accepted test or tests of cognitive function; and
  • evidence of progressive worsening in cognitive and daily functioning either by serial cognitive tests or by history over at least a 6-month period.

The Diagnosis must be made by a Specialist. No benefit will be payable under this condition for affective or schizophrenic disorders, or delirium. Reference to the Mini Mental State Exam is to Folstein MF, Folstein SE, McHugh PR, J Psychiatr Res. 1975;12(3):189.

Aortic Surgery is the undergoing of surgery for a disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta means the thoracic and abdominal aorta but not its branches. The surgery must be determined to be medically necessary by a Specialist. The Date of Diagnosis is the date you undergo the surgery for the Covered Condition. No benefit will be payable for angioplasty, intra-arterial procedures, percutaneous trans-catheter procedures, or non-surgical procedures.

Aplastic Anemia is a definite Diagnosis of a chronic persistent bone marrow failure, confirmed by biopsy, which results in anemia, neutropenia, and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the following; marrow stimulating agents; immunosuppressive agents; bone marrow transplantation. The Diagnosis of Aplastic Anemia must be made by a Specialist.

Bacterial Meningitis is a definite Diagnosis of meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture, resulting in neurological deficit documented for at least 90 days from the date of Diagnosis. The Diagnosis of Bacterial Meningitis must be made by a Specialist. No benefit will be payable under this condition for viral meningitis. The Survival Period is 90 days.

Benign Brain Tumour is a definite Diagnosis of a non-malignant tumour located in the cranial vault and limited to the brain, meninges, cranial nerves, or pituitary gland. The tumour must require surgical or radiation treatment or cause irreversible objective neurological deficits. The Benign Brain Tumour must be Medically Diagnosed by a neurologist. No benefit will be available under this condition for pituitary adenomas less than 10 mm.

No benefit will be payable if, within the first 90 days immediately following the later of, the date your insurance under this benefit became effective or the date of the last reinstatement, you had any of the following:

  • signs, symptoms, or investigations, that lead to a Diagnosis of Benign Brain Tumour, covered or excluded under the Policy, regardless of when the Diagnosis is made, or
  • a Diagnosis of Benign Brain Tumour, covered or excluded under the Policy

The medical information about the Diagnosis and any signs, symptoms, or investigations leading to the Diagnosis must be provided to Co-operators Life within 6 months of the date of the Diagnosis. If this information is not provided within this period, no benefit will be payable.

Blindness is a definite Diagnosis of the total and irreversible loss of vision in both eyes, evidenced by:

  • the corrected visual acuity being 20/200 or less in both eyes; or,
  • the field of vision being less than 20 degrees in both eyes.

Blindness must be Medically Diagnosed by an Ophthalmologist.

Burns is a definite Diagnosis of third-degree burns over at least 20% of the body surface. Burns must be Medically Diagnosed by a Specialist.

Coma is a definite Diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less. The Coma must be Medically Diagnosed by a Specialist.

No benefit will be available under this condition for:

  • a medically induced coma;
  • a Diagnosis of brain death, or
  • a coma, which results from alcohol or drug use.

Coronary Artery Bypass Surgery is the undergoing of heart surgery to correct the narrowing or blockage of one or more coronary arteries with bypass graft(s). No benefit will be payable for angioplasty, intra-arterial procedures, percutaneous trans-catheter procedures, or non-surgical procedures. The surgery must be determined to be medically necessary and Medically Diagnosed by a cardiologist. The Date of Diagnosis is the date you undergo the surgery for the Covered Condition.

Deafness is a definite Diagnosis of the total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 hertz. Deafness must be Medically Diagnosed by a Specialist.

Heart Valve Replacement or Repair is the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart valve defects or abnormalities. The surgery must be determined to be medically necessary by a Specialist. The Date of Diagnosis is the date you undergo the surgery for the Covered Condition. No benefit will be payable for angioplasty, intra-arterial procedures, percutaneous trans-catheter procedures, or non-surgical procedures.

Kidney Failure (End Stage Renal Disease) is a definite Diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis; peritoneal dialysis, or renal transplantation is initiated. Kidney Failure must be Medically Diagnosed by a Specialist.

Life-threatening Cancer – Cancer (Life-Threatening) is a definite Diagnosis of a tumour, which must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma. The Diagnosis of Cancer must be made by a Specialist.

No benefit will be payable under this condition if, within the first 90 days following the latter of, the effective date of your coverage under this benefit, or the date of the last reinstatement of coverage, you have any of the following:

  • signs, symptoms, or investigations, that lead to a Diagnosis of Cancer, covered or excluded under the Policy, regardless of when the Diagnosis is made; or
  • a Diagnosis of Cancer, covered or excluded under the Policy

Medical information about the Diagnosis and any signs, symptoms, or investigations leading to the Diagnosis must be reported to Co-operators Life within 6 months of the date of the Diagnosis. If this information is not provided within this period, no benefit will be payable for any claim for cancer or, any critical illness caused by any cancer or its treatment.

No benefit will be payable for the following:

  • lesions described as benign, pre-malignant, uncertain, borderline, non-invasive, carcinoma in-situ (Tis), or tumours classified as Ta;
  • malignant melanoma skin cancer that is less than or equal to 1.0 mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis;
  • any non-melanoma skin cancer, without lymph node or distant metastasis;
  • prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;
  • papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis;
  • chronic lymphocytic leukemia classified less than Rai stage 1; or
  • malignant gastrointestinal stromal tumours (GIST) and malignant carcinoid tumours, classified less than AJCC Stage 2.

The terms Tis, Ta, T1a, T1b, T1, and AJCC Stage 2 are to be applied as defined in the American Joint Committee on Cancer (AJCC) cancer staging manual, 7th Edition, 2010. The term Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy, and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.

Loss of Independent Existence is a definite Diagnosis of the total inability to perform, by oneself, at least two of the six Activities of Daily Living for a continuous period of at least 90 days with no reasonable chance of recovery. The Diagnosis of Loss of Independent Existence must be made by a Specialist.

Loss of Limbs is a definite Diagnosis of the complete severance of two or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation. The Diagnosis of Loss of Limbs must be made by a Specialist. The Date of Diagnosis is the date the limbs are severed.

Loss of Speech is a definite Diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease, for a period of at least 180 days. The Diagnosis of Loss of Speech must be made by a Specialist. No benefit will be payable for any psychiatric related causes.

Major Organ Transplant is a definite Diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys, or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Transplant, you must undergo a transplantation procedure as the recipient for transplantation of a heart, lung, liver, kidney, or bone marrow, and limited to these entities. The Date of Diagnosis is the date you undergo the surgery for the Covered Condition. The major organ failure must be Medically Diagnosed by a Specialist.

Major Organ Failure on Waiting List is a definite Diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys, or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Failure on Waiting List, you must become enrolled as the recipient in a recognized transplant center in Canada or the United States of America that performs the required form of transplant Surgery. For the purposes of the Survival Period, the Date of Diagnosis is the date of your enrollment in the transplant center. The major organ failure must be Medically Diagnosed by a Specialist.

Motor Neuron Disease is a definite Diagnosis of one of the following: amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy, or pseudobulbar palsy, and limited to these conditions. Motor Neuron disease must be Medically Diagnosed by a neurologist.

Multiple Sclerosis is a definite Diagnosis of at least one of the following:

  • two or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination; or
  • well-defined neurological abnormalities lasting more than 6 months, confirmed by MRI imaging of the nervous system, showing multiple lesions of demyelination; or
  • 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 one month apart.

Multiple Sclerosis must be Medically Diagnosed by a neurologist.

Myocardial Infarction (Heart Attack) is a definite Diagnosis of the death of heart muscle due to obstruction of blood flow that results in;

Rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following:

  • heart attack symptoms
  • new electrocardiogram (ECG) changes consistent with a heart attack
  • development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.

The Heart Attack must be Medically Diagnosed by a cardiologist.

No benefit will be available under this condition for:

  • elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty in the absence of new Q waves, or
  • ECG changes suggesting a prior myocardial infarction, which do not meet the Heart Attack definition as described above.

Occupational HIV Infection is a definite Diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of your normal occupation, which exposed you to HIV contaminated body fluids. The accidental Injury leading to the infection must have occurred after the effective date of your coverage under this benefit, or the date of last reinstatement of coverage.

Payment under this condition requires satisfaction of all of the following:

  • the accidental injury must be reported to Co-operators Life within 14 days of the accidental injury;
  • a serum HIV test must be taken within 14 days of the accidental injury and the result must be negative;
  • a serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
  • all HIV tests must be performed by a duly licensed laboratory in Canada or the United States of America; and,
  • the accidental injury must have been reported, investigated, and documented in accordance with current Canadian or United States of America workplace guidelines.

The Diagnosis of Occupational HIV Infection must be made by a Specialist.

No benefit will be payable under this condition if:

  • you have elected not to take any available licensed vaccine offering protection against HIV; or,
  • a licensed cure for HIV infection has become available prior to the accidental injury; or,
  • HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use.

Paralysis is a definite Diagnosis of the total loss of muscle function of two or more limbs as a result of injury or disease to the nerve supply of those limbs, for a period of at least 90 days following the precipitating event. The Diagnosis of Paralysis must be made by a Specialist.

Parkinson’s Disease and Specified Atypical Parkinsonian Disorders are defined as a definite Diagnosis of primary Parkinson’s disease, a permanent neurologic condition, which must be characterized by bradykinesia (slowness of movement) and at least one muscular rigidity or rest tremor. You must exhibit objective signs of progressive deterioration in function for at least one year, for which the treating neurologist has recommended dopaminergic medication or other generally medically accepted equivalent treatment for Parkinson’s disease.

Specified Atypical Parkinsonian Disorders are defined as a definite Diagnosis of progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy.

The Diagnosis of Parkinson’s Disease or a Specified Atypical Parkinsonian Disorder must be made by a neurologist.

No benefit will be payable under Parkinson’s disease and Specified Atypical Parkinsonian Disorders for any other type of parkinsonism.

Parkinson’s Disease and Specified Atypical Parkinsonian Disorders Exclusion Period:

No benefit will be payable for Parkinson’s Disease or Specified Atypical Parkinsonian Disorders if, within the first year following the latter of, the effective date of your coverage under this benefit, or the date of the last reinstatement, you have any of the following:

  • signs, symptoms, or investigations that lead to a Diagnosis of Parkinson’s Disease, a Specified Atypical Parkinsonian Disorder, or any other type of parkinsonism, regardless of when the Diagnosis is made; or
  • a Diagnosis of Parkinson’s Disease, a Specified Atypical Parkinsonian Disorder, or any other type of parkinsonism.

Medical information about the Diagnosis and any signs, symptoms, or investigations leading to the Diagnosis must be reported to Co-operators Life within 6 months of the date of the Diagnosis. If this information is not provided within this period, no benefit will be payable for any claim for Parkinson’s disease or Specified Atypical Parkinsonian Disorders or, any critical illness caused by Parkinson’s disease or Specified Atypical Parkinsonian Disorders or its treatment.

Stroke or Cerebrovascular Accident (CVA) is a definite Diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or hemorrhage, or embolism from an extra-cranial source with acute onset of new neurological symptoms and new objective neurological deficits on clinical examination, both of which persist for more than 30 days following the Date of Diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing. The Stroke must be Medically Diagnosed by a Specialist.

No benefit will be available under this condition for:

  • Transient Ischemic Attacks; or,
  • Intracerebral vascular events due to trauma; or,
  • Lacunar infarcts, which do not meet the definition of stroke as described above.

Covered Conditions Critical Illnesses – Partial Benefits

Coronary Angioplasty is the undergoing of an interventional procedure to unblock or widen a coronary artery that supplies blood to the heart to allow an uninterrupted flow of blood. The procedure must be Diagnosed and determined to be medically necessary by a Specialist. The Date of Diagnosis is the date you undergo the procedure.

Chronic Lymphoma Leukemia (CLL), early-stage Chronic Lymphocytic Leukemia is defined as a malignant proliferation of lymphocyte white blood cells. The Diagnosis of chronic lymphocytic leukemia must be made by an approved Specialist. The chronic lymphocytic leukemia must be classified as Rai stage 0 where there is an increase in blood lymphocytes but there is no enlargement of lymph nodes, liver, or spleen, and there is no anemia or thrombocytopenia. No benefit will be payable for monoclonal B-cell lymphocytosis (MBL), lymphoma, or other causes of lymphocytosis. For purposes of the Policy, the term Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy, and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.

Carcinoma in situ of the breast, early-stage ductal breast Carcinoma in situ is the presence of malignant breast cancer cells that remain within the cell group from which they arose, where cancer cells do not penetrate the basement membrane nor invade the surrounding tissues. The Diagnosis of ductal breast carcinoma in situ must be confirmed with a valid pathology report by a certified pathologist and it must be classified as “Tis” according to the AJCC 7th Edition TNM staging method or FIGO Stage 0 of the Federation Internationale de Gynaecologie et d’Obstetrique staging system. Lobular breast carcinoma in-situ is excluded.

Malignant Melanoma, early-stage Malignant Melanoma is an invasive malignant melanoma of the skin that is less than or equal to 1.0 mm in Breslow thickness and is non-ulcerated and there is no spread to lymph nodes or distant metastases. There must be uncontrolled growth and spread of malignant melanoma cells that invade past the epidermis into the dermis of the skin. The Diagnosis must be confirmed with a valid pathology report and a report from an approved Specialist. No benefit will be payable for melanoma in-situ.

Prostate Cancer, early-stage Prostate Cancer is an invasive malignant prostate cancer that is characterized by the uncontrolled growth and spread of malignant prostate cancer cells that invade the prostate gland. The cancer must be confined to the prostate gland with no spread to lymph nodes or distant metastases and classified as stage T1a or T1b by the AJCC 2010 Seventh Edition TNM Classification. The Diagnosis must be confirmed with a valid pathology report and a report from an approved Specialist. No benefit will be payable for any grade of Prostatic Intra-epithelial neoplasia (PIN) or prostate cancer in situ.

Thyroid Cancer, early-stage Thyroid Cancer is an invasive malignant papillary or follicular thyroid cancer that is characterized by the uncontrolled growth and spread of malignant thyroid cancer cells that invade the thyroid gland. The cancer must be confined to the thyroid gland with no spread to lymph nodes or distant metastases. The thyroid cancer must be 2.0 cm or less in greatest diameter in size and classified as stage T1 by the AJCC 2010 Seventh Edition TNM Classification. The Diagnosis must be confirmed with a valid pathology report and a report from an approved Specialist. No benefit will be payable for benign thyroid nodules.

Partial Benefits – Cancer exclusion

No benefit will be payable under the Partial Benefit if, within the first 90 days following the latter of, the effective date of your coverage under this benefit, or the date of the last reinstatement of coverage, you have any of the following:

  • signs, symptoms, or investigations, that lead to a Diagnosis of cancer, regardless of when the Diagnosis is made; or
  • a Diagnosis of cancer.

Medical information about the Diagnosis and any signs, symptoms, or investigations leading to the Diagnosis must be reported to Co-operators Life within 6 months of the Date of Diagnosis. If this information is not provided within this period, no benefit will be payable for any claim for cancer or any Critical Illness caused by any cancer or its treatment.

Total Disability Waiver of Premium

If premiums for your Basic Life Insurance coverage under the Policy are being waived, then premiums for the Critical Illness coverage will also be waived but only so long as this benefit and the Plan sponsor’s coverage under this benefit remains in force.

Critical Illness Limitations and Exclusion

(1)  No Critical Illness Benefit will be paid if your condition, either directly or indirectly, was caused by, was contributed to by, resulted from, or was in any manner associated with one or more of the following:

  • attempted suicide or self-inflicted Injury or Sickness, regardless of mental state, or
  • committing or attempting to commit a criminal offense or provoking an assault, or
  • a situation where the Critical Illness results from Injuries sustained in, or directly or indirectly from, a Vehicle accident where you were driving the Vehicle involved in the accident and had either:
    • alcohol in your blood in excess of 80 milligrams of alcohol per hundred millilitres of blood; or
    • your ability to operate the Vehicle impaired by drugs or alcohol or a combination of the two; or
  • any poison gas or fumes, voluntarily or otherwise taken, administered, absorbed or inhaled, or
  • the use of alcohol or the use of any medication or drugs, voluntary or otherwise taken, administered, absorbed or inhaled, other than taken as prescribed by a Physician, or
  • insurrection, riot, hostilities of any kind, war (whether war be declared or not), or active service in the armed forces of any country.
  • treatment for injury or illness caused by activities such as hunting, mountaineering, professional sports, racing of any kind, scuba diving, aerial sports, hang gliding, ballooning, and aviation other than as a fare-paying passenger in a commercial licensed aircraft.
  • medical care which is not medically necessary or which is of a cosmetic nature. The donation of an organ or tissue will be considered as necessary medical care.

(2)  No Critical Illness Benefit will be paid where you fail to seek Reasonable and Customary Treatment in order to circumvent the waiting period or other conditions and restrictions applying to this benefit.

When to submit a Critical Illness claim

Your critical illness claim form must be submitted to us within 3 months from the date the illness was diagnosed.

Failure to furnish proof within this time will not invalidate nor reduce any claim if it is shown not to have been reasonably possible to furnish the proof and that the proof was furnished as soon as was reasonably possible, but in no event will this be more than 12 months from the date of diagnosis.