Case Study: How One Client's Diligence Secured $25,000 in Benefits

The Unexpected Health Scare

Mark, a 55-year-old self-employed engineer, was living a busy, productive life when everything changed on April 1st, 2024. What started as burning chest pain, particularly after meals and physical exertion, quickly escalated into something far more serious.

By April 5th, the pain had become concerning enough that Mark sought immediate medical attention. He was admitted to the hospital with a diagnosis of unstable angina - a clear warning sign that his heart was in distress.

The diagnostic tests revealed the stark reality: a coronary angiogram showed a dangerous 90% blockage in his proximal left anterior descending (LAD) artery, often called the "widow maker" due to its critical role in heart function.

On April 9th, Mark underwent a percutaneous coronary intervention (PCI), where doctors inserted a drug-eluting stent to restore proper blood flow. After five days across two hospitals, he was discharged with a cardiac rehabilitation plan and a new perspective on life.

The Insurance Discovery

During his recovery, Mark remembered something important: he owned a Critical Illness insurance policy that he had purchased through Garrett Agencies. Like many policyholders, he had filed away his policy documents after purchase, hoping never to need them.

Now facing a serious cardiac event and potential time away from work, Mark retrieved his policy and began carefully reading through the coverage details. The full Critical Illness benefit definitions seemed strict, and he wasn't immediately certain his condition would qualify for the complete $100,000 payout.

However, as he continued reading, Mark discovered something he hadn't initially noticed: the Early Intervention Benefit (EIB) provision. This feature offered potential coverage for certain conditions that, while serious, might not meet the stringent requirements for full Critical Illness benefits.

The Important Call

Rather than making assumptions about his coverage, Mark made a decision that would prove invaluable. He contacted Garrett Agencies for professional guidance. This call initiated a process that would ultimately result in a successful claim.

Our team immediately notified the insurance company of the potential claim and requesting all necessary documentation. We provided Mark with a comprehensive claim kit containing all required forms for both him and his attending physician to complete.

Throughout this process, we emphasized the importance of thorough documentation and timely submission. Our experience has shown that well-prepared claims with complete medical records typically receive faster processing and clearer outcomes.

The Claim Process

Mark and his physician diligently completed all required paperwork, including detailed medical reports, discharge summaries, and procedural documentation. The medical timeline was clear and well-documented:

• April 1: Symptom onset
• April 5: Hospital admission with unstable angina
• April 9: Diagnosis of 90% LAD stenosis and immediate PCI with stent placement
• April 10: Discharge after successful procedure

With all documentation assembled, the claim was submitted to the insurance company for review.

The Outcome: When Preparation Pays Off

On April 21st, 2024, the insurance company rendered their decision. As Mark had suspected, his condition did not meet the policy's strict definition for a full Critical Illness benefit payout. However, his diligence in reading his policy and seeking professional guidance paid off significantly.

The claim was approved under the Early Intervention Benefit provision, resulting in a $25,000 lump-sum payment (25% of his full Critical Illness benefit). The funds were transferred electronically, providing immediate financial relief during his recovery period.

Importantly, Mark's policy remains fully active. Even though he received the Early Intervention Benefit payout, he still retains $75,000 in Critical Illness coverage. Should he experience a future critical illness that meets the policy's full benefit criteria, his coverage would respond with the remaining benefit amount.

Understanding Critical Illness vs. Early Intervention Benefits

This case highlights an important distinction that many policyholders don't fully understand:

‍Full Critical Illness Benefits typically require very specific medical criteria to be met. For cardiac events, this might include:

• Heart attack with specific enzyme levels and ECG changes
• Coronary artery bypass surgery
• Major cardiac procedures requiring open-chest surgery

Early Intervention Benefits recognize that serious medical conditions requiring significant treatment (like Mark's 90% arterial blockage and stent placement) represent major health events deserving of financial support, even when they don't meet the strict technical definitions for full benefits.

The EIB provision typically pays 25% of the full benefit amount, up to a maximum of $25,000 to $50,000, and can only be claimed once per insured person.

The Four Keys to Success

Mark's successful claim resulted from four critical factors:

• Having Coverage in Place: Years earlier, Mark had worked with Garrett Agencies to secure Critical Illness insurance, recognizing the financial risks that serious health events could pose to his self-employed income.
• Reading His Policy: Rather than making assumptions, Mark took time to carefully review his policy documents and discovered the EIB provision.
• Seeking Professional Guidance: Instead of navigating the claim process alone, Mark contacted his insurance professionals for expert assistance.
• Professional Facilitation: Garrett Agencies expedited the claim process through proper documentation, timely submission, and ongoing communication with the insurance company.

The Broader Lesson

Mark's experience illustrates an important truth about insurance: policies often contain valuable provisions that policyholders may not fully understand or remember. In this case, what initially seemed like uncertain coverage became a meaningful "yes" for substantial financial support.

Without professional guidance, Mark might have assumed his claim wouldn't be covered and never pursued it at all. The difference between receiving nothing and receiving $25,000 came down to knowledge, preparation, and having the right support team.

Protecting Your Financial Future

Critical Illness insurance serves as a financial bridge during health crises, helping to replace lost income, cover additional medical expenses, or simply provide peace of mind during recovery. However, as Mark's story demonstrates, the value extends beyond just the basic coverage - it's also about understanding your policy and having professional support when you need it most.

Whether you're considering Critical Illness insurance for the first time or reviewing existing coverage, working with experienced professionals ensures you fully understand your protection and can maximize your benefits when the unexpected occurs.

Ready to explore Critical Illness insurance for your family?

Contact Garrett Agencies today to speak with a licensed professional advisor who can help you understand your options and find coverage that fits your needs.