Accident and Sickness Insurance
Core concepts
Accident and sickness (A&S) insurance pays disability income or medical expense benefits. Definitions drive the claim: an accident is usually sudden, unintentional, and external; sickness must first manifest after the policy is in force. Know the waiting or elimination period before benefits begin, the benefit period maximum, and any probationary period for sickness. Indemnity policies pay a fixed amount; reimbursement policies pay actual expenses up to a limit. Disability definitions may be own occupation or any occupation, total or partial/residual. Renewability matters: non-cancellable, guaranteed renewable, and conditionally renewable have different guarantees. Benefits may coordinate with CPP, WCB, or group plans to avoid overinsurance. Common exclusions include self-inflicted injury, war, cosmetic treatment, normal pregnancy, and pre-existing conditions.
Traps
Do not confuse the waiting period with the benefit period. Own-occupation and any-occupation definitions can change the outcome. Watch recurrence clauses, pre-existing-condition wording, and whether the policy is occupational or non-occupational. AD&D pays only for accidental death or dismemberment, not illness. Disability is usually based on income loss and medical proof, not diagnosis alone. Indemnity pays the stated amount regardless of actual expenses. Claims require timely notice and proof of loss.
Worked example
A policy pays $3,000 monthly after a 90-day elimination period for up to 24 months. The insured is disabled January 1. Benefits begin after the elimination period, roughly April 1, and can run for the benefit period stated. If the insured returns part-time, a residual benefit may top up income, subject to the definition and coordination. Rule of thumb: match the claim facts to the exact definition and time period before calculating any benefit.