Why won’t your insurer pay your Critical Illness cover?

Much has been written about critical illness (CI) products over the past couple of years. This has highlighted both negatives and positives about the complicated type of insurance cover.

Research has shown there is a lack of trust in some of claim processes and procedures that are creeping in. Even more concerning is the concern that insurers aim not to pay these costly claims if it is at all possible.

This has been reinforced by a claims statistics being widely available that are not 100 per cent comparable.

The insurance industry as a whole needs to educate customers not just about the products, but also around processes and procedures of making a claim on these policies. 

Standard Life declined to pay 14 per cent of critical illness claims in the first half of 2006, according to its claims statistics.

In the first half of 2006, 6 per cent of claims were declined because the claim did not meet policy definitions and 8 per cent were declined because of non-disclosure.

Overall, Standard Life paid out £9.8 million in 184 CI claims with an average claim value of £53,546. The largest claim paid was £300,000.

Standard Life Assurance protection marketing manager said: “The level of declined claims is disappointing. Hopefully, the work of the Association of British Insurers (ABI), through the Statement of Best Practice, will help reduce the number of declined claims and start to rebuild trust in an industry which strangely enough does not like to decline claims.”

The country's largest insurer, Norwich Union, also refused to pay out on almost a quarter of its critical illness claims in 2005.

It turned down a total of 23 per cent of claims in 2005 stating that policyholders failed to either disclose medical conditions or comply with terms and conditions.

The insurer declined 12 per cent of claims due to non-disclosure of medical facts when policies were taken out and a further 11 per cent of cases because policy conditions had not been met.

The figures were down slightly on 2004, when 13 per cent of claims were rejected due to non-disclosure and the same proportion on account of non-compliance with policy criteria.

Norwich Union said the group was striving to find ways to reduce levels of non-disclosure.

In 2006 the insurer introduced a "full disclosure fact sheet" in its information packs to drive home the importance of completing application forms "carefully, accurately and completely".

Experts have said that the issue of non-disclosure was a "major one" and have urged consumers to ensure they disclosed their full medical history and selected the most appropriate policy for their circumstances.

The claims figures were unveiled as the Association of British Insurers said it was taking further steps to protect consumers when buying life, critical illness and income protection insurance.

Insurance companies have said in light of the figure that they are now working on proposals designed to make applying for these types of insurance over the phone and Internet clearer.

Statistics over the past couple of years in relation to critical illness claims have shown that 60 per cent of claimants were aged between 40 and 59, 32 per cent were aged between 0 and 39, and 8 per cent were over the age of 60.

The top five causes for claims were cancer, heart attack, multiple sclerosis, stroke and benign brain tumour.

Critical illness cover can be an important contract for those concerned about protecting their finances in case of serious ill health and with the level of debt that now exists in the UK coupled with the lack of savings to provide a fiancial cushion, critical illness cover can be one of a variety of useful policies.