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Critical Illness Insurance

Critical Illness Recovery Plan Terms and Conditions


Underwitten by TD Life Insurance Company under Policy TDL018

What follows is a summary of the Certificate of Insurance. For the full terms and conditions of the Critical Illness Recovery Plan, please refer to the Certificate of Insurance, which will be sent to you if an application which you have submitted is accepted by TD Life Insurance Company, a member of TD Bank Financial Group. In the event of a conflict, the Certificate of Insurance will govern.



Definitions Of The Terms We Have Used

This Certificate of Insurance uses the following terms, which have the first letter(s) capitalized:

Accident means an accident that occurs to an Insured Person while that Insured Person is insured under this Certificate.

Accidental Death means loss of life caused directly by an Accident, independently of any other causes, and which occurs within (365) days of that Accident.

Acute Heart Attack means the death of a portion of your heart muscle resulting from inadequate blood supply for which the following test results are confirmed:

  • An increase of cardiac bio-markers and/or enzymes found in the blood stream, as a result of damaged heart muscle tissue, to levels considered diagnostic for an acute myocardial infarction.

Diagnosis of the Acute Heart Attack must be made by a physician qualified to make the Diagnosis.
however, Acute Heart Attack does not include:

  1. an incidental finding of ECG changes suggesting a prior myocardial infarction with no corroborating event; or
  2. an increase of cardiac bio-markers and/or enzymes due to coronary angioplasty (a medical procedure involving the ballooning of a narrowed coronary artery) unless there are new elevations of ST segments in the involved ECG leads considered diagnostic for an acute myocardial infarction; or
  3. an increase of cardiac bio-markers and/or enzymes in the blood stream due to pericarditis or myocarditis.

Cancer (Life-Threatening) means a life-threatening tumour characterized by the uncontrolled growth and spread of malignant cells;
however, Cancer (Life-Threatening) does not include:

  1. carcinoma in situ;
  2. malignant melanoma to a depth of 0.75 mm or less;
  3. any skin cancer that has not spread beyond the deepest layer of the skin;
  4. Kaposi’s sarcoma;
  5. Cancer of the prostate, regardless of stage or extent of malignancy;
  6. any cancer diagnosed in the first (90) days of the Issue Date.

Covered Critical Illness means Acute Heart Attack, Cancer (Life-Threatening) or Stroke as defined in this Certificate;
however, Covered Critical Illness does not include:

  1. Acute Heart Attack, Cancer (Life-Threatening) or Stroke occurring within the first (6) months after an Insured Person’s Issue Date as a result of an illness or condition for which an Insured Person had symptoms, received medical consultation, treatment, care or services, including prescribed medication during the (6) month period prior to an Insured Person’s Issue Date; or
  2. Acute Heart Attack, Cancer (Life-Threatening) or Stroke:
    1. which  developed from an illness or condition  which was being investigated within the first (6) months after an Insured Person’s Issue Date; and
    2. in regard to such illness or condition, an Insured Person had symptoms, received medical consultation, treatment, care or services, including prescribed medication during the (6) month period prior to an Insured Person’s Issue Date.

Diagnosis of and Diagnosed with a Covered Critical Illness refers to meeting the definition of the applicable Covered Critical Illness as defined in this Certificate.

Insured Person means You, and if indicated in the COVERAGE SCHEDULE, Your Spouse.

Physician means a qualified doctor, licensed and practising medicine in Canada.

Policy means Group Policy TDL018 issued by the Insurer to The Toronto-Dominion Bank.

Spouse means:

  1. the person to whom You are lawfully married; or
  2. Your designated partner who has lived with You for at least (2) years and continues to live with You and is publicly represented as Your partner.

Stroke means a cerebrovascular event producing neurological sequelae lasting more than (30) days and caused by thrombosis, hemorrhage, or embolism from an extra-cranial source, and for which there is evidence of measurable, objective neurological deficit;
however, Stroke does not include:

  1. transient ischemic attacks.

Who Is Eligible For Coverage

In Your application, You confirmed that You were eligible for this coverage.

To be eligible for insurance coverage under this Certificate, you must be a customer of TD Bank Financial Group, and an Insured Person must:

  1. be a Canadian resident; and
  2. be in the Insured Person’s home province/territory at time of enrollment; and
  3. be between the ages of 18 and 54 on the Insured Person’s Issue Date; and
  4. never had or never been told he/she had cancer, heart attack or stroke and must not be currently under investigation for having cancer, a heart attack or a stroke.

When We Will Pay An Insurance Benefit

Critical Illness Benefit
When an Insured Person, while insured, is Diagnosed with a Covered Critical Illness and survives for (30) days (until 12:01 am of the 31st day) following the date of Diagnosis, the Insurer will pay to You the Critical Illness Benefit amount as indicated in the COVERAGE SCHEDULE for that Insured Person.

Only (1) Critical Illness Benefit per Insured Person is payable under this Certificate.

Note: Please refer to the section “DEFINITIONS OF THE TERMS WE HAVE USED” for further information on what is a “Covered Critical Illness”

Optional Accidental Death Insurance
This benefit is only applicable if specifically included in the COVERAGE SCHEDULE.

If You, while insured, suffer an Accidental Death, the Insurer will pay to Your beneficiary or beneficiaries the Optional Accidental Death Insurance amount specified in the COVERAGE SCHEDULE for You. If You have not elected any beneficiary or beneficiaries, Your Optional Accidental Death Insurance benefit will be paid to Your Estate.

The right to designate or change a beneficiary is reserved for You.  To designate or change a beneficiary, You may request a “Beneficiary Designation” form be sent to You from the Insurer for completion and return. The Insurer will verify the beneficiary(ies) and confirm back any changes that have been made in writing.

If Your Spouse, while insured, suffers Accidental Death, the Insurer will pay to You the Optional Accidental Death Insurance amount as indicated in the COVERAGE SCHEDULE for Your Spouse.

The amount of Optional Accidental Death coverage on an Insured Person will reduce by 50% when that Insured Person turns 65.

When We Will Not Pay An Insurance Benefit

We will not pay an insurance benefit if:

  1. Your claim is made more than (1) year after the date of Diagnosis or death; or
  2. Your claim is caused directly or indirectly by the use of illegal or illicit drugs or substances, or misuse of medication obtained with or without a prescription.

We will not pay an insurance benefit and will void all insurance coverages under this Certificate if:

  1. An Insured Person gives any false or incomplete responses to requests for information that We require to assess an Insured Person’s eligibility for coverage; or
  2. An Insured Person gives any false or incomplete responses to requests for information that We require to determine an Insured Person’s Smoking Status; or
  3. An Insured Person gives any false or incomplete information when requesting any change to either Your or Your Spouse’s coverage; or
  4. An Insured Person had cancer, a heart attack or a stroke prior to that Insured Person’s Issue Date; or
  5. An Insured Person had been under investigation at the time of that Insured Person’s application for having cancer, a heart attack or a stroke.

This applies to the responses in an Insured Person’s Application, or any other information We receive from an Insured Person, whether in writing, electronically or by telephone.

We will not pay a Critical Illness Benefit:

  1. unless an Insured Person is Diagnosed with a Covered Critical Illness as defined in the DEFINITIONS OF THE TERMS WE HAVE USED section of this Certificate; or
  2. if an Insured Person has cancer within the first (90) days of that Insured Person’s Issue Date.

We will not pay an Optional Accidental Death Insurance benefit for an Insured Person under this Certificate if:

  1. an accident occurs before insurance coverage comes into effect on that Insured Person;
  2. that Insured Person’s death occurs before insurance coverage came into effect; or
  3. that Insured Person’s death is caused or contributed to by an illness or sickness; or
  4. that Insured Person’s death is caused by or results from events transpiring during the commission, or an attempted commission, of a criminal offence (including driving a motor vehicle while legally intoxicated); or
  5. that Insured Person’s death is a result of suicide, attempted suicide, or intentionally self-inflicted injury;
  6. that Insured Person’s death is a result of bodily or mental infirmity or disease of any kind including but not limited to stress and diabetes;
  7. that Insured Person’s death is a result of war, declared or undeclared, or any act thereof;
  8. that Insured Person’s death is a result of participation in professional sports, any speed contest, SCUBA diving unless you hold a basic SCUBA designation from a certified school, parachuting, hang gliding, bungee jumping, or skydiving;
  9. that Insured Person’s death is a result of air travel as a pilot or crew member of any conveyance used for aerial navigation.

When Your Insurance Coverage Ends

All coverages under the Certificate will end on the date when any of the following occurs:

  1. You are Diagnosed with a Covered Critical Illness for which a Critical Illness Benefit is payable;
  2. You die;
  3. We receive a verbal or written request from You to cancel Your insurance;
  4. the Premium payment is in arrears for (30) days;
  5. (30) days after We give You written notice of the termination of the Group Policy;
  6. You turn 70 years old;
  7. You have cancer within the first (90) days after Your Issue Date. When this occurs, We will refund all premiums paid from Your Issue Date;
  8. You have a claim denied as a result of submitting false information in support of a claim (as detailed in the WHEN WE WILL NOT PAY AN INSURANCE BENEFIT section in this Certificate).

In addition, all coverages for Your Spouse, if insured, will also end on the date when any of the following occurs:

  1. Your Spouse is Diagnosed with a Covered Critical Illness for which a Critical Illness Benefit is payable;
  2. Your Spouse dies;
  3. Your Spouse turns 70 years old;
  4. Your Spouse has cancer within the first (90) days after Your Spouse’s Issue Date. When this occurs, We will refund all premiums for the Spouse’s coverage from the Spouse’s Issue Date;
  5. We receive Your request to terminate coverage on Your Spouse;
  6. Your Spouse no longer qualifies under the definition of Spouse;
  7. Your Spouse has a claim denied as a result of submitting false information in support of a claim (as detailed in the WHEN WE WILL NOT PAY AN INSURANCE BENEFIT section in this Certificate).

If a claim has been submitted to Us for either You or Your Spouse, premiums should still be paid to avoid coverage from ending should the claim not be approved. If the claim is approved, We will refund any premiums We may owe back to the date coverage ended.

Other General Conditions About Your Coverage

What if the age or gender of an Insured Person is incorrect?
If a Certificate is issued providing coverage on a person based on an incorrect age or gender:

  1. if the Insured Person is still eligible for insurance, the Amount of Coverage will be adjusted to the level that the premiums actually paid would have provided had they been based on the correct date of birth and/or gender at Issue Date of that Insured Person; or
  2. if the Insured Person is not eligible for insurance based on the Insured Person’s actual age, all coverages under this Certificate will be rescinded and the Insurer will refund all premiums You have paid.

What if an Insured Person is covered as a smoker and wants to apply for non-smoker rates?
An Insured Person, approved under smoker rates, may apply for non-smoker rates, subject to medical underwriting and Insurer approval.

What if information about an Insured Person is given to the Insurer incorrectly?

If You:

  1. fail to make full, complete and truthful disclosure in response to all questions during the enrollment process (on the Application on the telephone, internet or on paper) and on any other documents submitted to determine your eligibility for coverage; or
  2. fail to tell the Insurer every fact that is important for issuing You coverage or assessing your eligibility for Your coverage.

then the insurance under this Certificate can be voided by the Insurer.

Information provided in Your Application Form or during the application process on the telephone or on the internet, or in any other document that are fraudulent may be challenged by the Insurer at any time. Other information or statements provided by You can be challenged by the Insurer within (2) years after the information or statements are provided to the Insurer.

Can any of the conditions under this coverage be waived?
The Insurer shall not be deemed to have waived or changed any condition of this Certificate, either in whole or in part, unless such waiver or change is clearly expressed in writing and signed by an officer of the Insurer.

What if You pay the premium after the premium payment date?
If a payment is not made by its due date, the Insurer will allow a grace period of (30) days, during which time this Certificate will remain in force. However, if payment is not made by the end of the grace period, Your coverage will end.

Legal Action:
No action at law or in equity shall be brought to recover on the Certificate prior to the expiration of (120) days after Proof of Claim has been furnished in accordance with the requirements of the Certificate, nor shall any such action be brought at all unless within (3) years after the expiration of the time within which Proof of Claim is required.

Can You transfer this coverage to someone else?
This Certificate may not be transferred or assigned to anyone else.

Are there any cash values to this coverage? Do I receive any profits or dividends from the Insurer?
This Certificate and the Group Policy under which it was issued do not distribute profits or dividends to its Certificate holders and this Certificate and Group Policy TDL018 have no cash values.

Related Topics:

Four Key Recovery Needs
Critical Illness Recovery Plan FAQ