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Do I qualify for critical illness insurance if I’ve had a stroke?

Protect yourself and your family from the financial consequences of brain damage.

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Richard Laycock
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A stroke can severely limit your communication skills, mobility and independence — in some cases, permanently. Critical illness insurance can help with the cost of care.

What is critical illness insurance?

Critical illness insurance provides a lump sum payout if you suffer from a serious medical condition, such as a stroke. This lump sum can provide you and your family with resources to assist with medical expenses and rehabilitation, plus help cover lost income and any other unexpected expenses. It can be purchased independently or added to a life insurance policy.

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How do insurers define strokes?

Insurers will often require a certain threshold to be met before defining a stroke. Threshold requirements will vary between insurers and can include:

Time frame

The amount of time between showing symptoms of a stroke and receiving medical attention has a big impact on how severe and/or permanent it’s likely to be. As such, insurers will often use a definition of stroke that relates to the time frame. For instance, some insurers will require that the onset of treatment is greater than 24 hours before it’s defined as a stroke.

Diagnosis confirmed by a neurologist

Some insurers may require a stroke diagnosis to be confirmed by a specialist, as other, more easily treatable diseases may initially imitate stroke symptoms.

Clinical evidence

Some insurers may require a series of diagnostic tests to have been undertaken. This can include:

  • A computed tomography (CT) scan.
  • A magnetic resonance image (MRI) scan.

Conditions to be cautious of

  • All evidence needs to support your insurer’s definition. Some insurers may decline claims based on one aspect of clinical evidence, despite the effect of the stroke on the policyholder and other clinical evidence supporting the diagnosis. In the event of a potential claim, contact your insurer before filing to find out what evidence will be required.
  • Payment amounts can vary. Recovery from a stroke is based on a number of factors and can range from full recovery within a month to a lifetime of severe impairment. The payout for a stroke can vary enormously depending on whether an insurer is paying for short-term medical treatments and care or an entire lifetime of around-the-clock care.

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Strokes in the US

According to the CDC, over 795,000 people have a stroke each year in the US, about a third of whom are under the age of 65. The total cost of treating stroke victims in the US, including medical care, medications and missed work, is $34 billion. Strokes are one of the leading causes of long-term disability in the country.

Critical illness insurance can often help during this period of financial need, covering caregiving, copays/deductibles and missed work that health insurance won’t pay for. It can also help with any changes that may have to be made around the house to improve access — half of all stroke victims over the age of 65 suffer from reduced mobility.

What is a stroke?

A stroke is a sudden loss of blood flow to an area of the brain, usually resulting in cell death. There are two types of strokes:

  • Hemorrhagic. This type of stroke occurs when a blood vessel ruptures either inside or near the brain, causing swelling and pressure that damage cells and tissue in the brain.
  • Ischemic. This is the most common type of stroke, and it happens when an artery feeding blood to the brain becomes blocked. If the blockage cuts off blood supply for more than a couple of minutes, affected brain tissue begins to die.

Must read: Transient ischemic attacks (TIAs)

While not technically a stroke, a TIA will have the same symptoms, though they’ll clear within 24 hours. However, that doesn’t mean you’re out of the woods — a TIA is often a warning sign that a far more serious ischemic stroke is pending.

Risk factors

Avoiding risk factors can help you reduce your chances of suffering from a stroke. Top risk factors include:

  • Obesity. Obesity often results in high blood pressure, high cholesterol, heart disease and type 2 diabetes, all of which increase your risk of experiencing a stroke. Diet and exercise can help control obesity and reduce your risk.
  • High cholesterol. Even seemingly fit people can suffer from high cholesterol, which can increase your likelihood of throwing a clot. It can be managed with the proper medication and diet.
  • Diabetes. If you have diabetes, you’re more likely to have a stroke, but eating well, exercising regularly and following your doctor’s advice can reduce your risk.
  • High blood pressure. Clinically known as hypertension, high blood pressure is one of the main causes of stroke. High blood pressure can be controlled with proper medication, a strict diet and regular exercise.
  • Smoking. Smoking results in plaque building up in your arteries, which, in turn, creates high blood pressure. It also reduces the amount of oxygen in your blood, increasing the likelihood of a fatal stroke.
  • Alcohol. Any more than two standard drinks a day can lead to high blood pressure, especially as you age.
  • Heart conditions. Many heart conditions increase your chances of having a stroke. Take your medications regularly, listen to your doctor’s advice and don’t skip appointments.
  • Age. Age is the biggest risk factor, and it’s not one you can control. However, you can reduce your risk with regular checkups, healthy eating and an active lifestyle.

The importance of FAST

In the event of a stroke, even an hour can be the difference between a speedy recovery and permanent brain damage. Use the acronym FAST to help remember the symptoms to look out for, and visit the emergency room or call 911 immediately if you think you or a loved one may be having a stroke.

F – Facial weakness.

A – Arm weakness.

S – Speech difficulties.

T – Time to act – fast.

What should I do if I think someone is having a stroke?

Sufferers should always, without exception, be taken to the nearest emergency care hospital as soon as possible. Urgent medical treatment is always needed to treat anybody suffering from a stroke, and waiting can be fatal. If the stroke victim is unconscious, they may require airway support including mechanical ventilation in order to prevent respiratory failure.

If you think you may be having a stroke, call 911. Do not attempt to drive yourself to the hospital.

Bottom line

Rehabilitation after a stroke is costly and time-consuming, and may be of only limited help if the stroke was severe. Critical illness insurance can make sure you have access to the care you need and your family is taken care of.

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