Help with Claiming on Critical Illness Policy

pedro123456

People with this condition, (even if their IC's cover it) and all the other CI conditions have to meet the IC's definition not the Dr's diagnosis, and that’s my point.

It's irrelevant what the GP/Consultant diagnose the condition has to meet the IC's definition. And that’s a fact not a opinion.

So irrespective of “who” the cover is with its irrelevant unless the IC’s embellished definition is made.


And actually, lack of CC isn't my opinion it's the ABI's.

Z

OshayAway

There isn't a criteria for it to meet because it is not a condition covered by any critical illness policy. It's as simple as that.

Suzanne7173

[FONT=arial, verdana][SIZE=-1][FONT=arial,verdana][SIZE=-1]Thank you for all your responses. Just to confirm my husband has had fulminant ulcerative colitis which was life threatning and resulted in an ileostomy being performed as part of emergency surgery and wouldn't you know meets the Prudential definition below completley. I really appreciate those of you who have checked cover under other insurers. I am surprised that given how common Crohns and Ulcerative Colitis are there is only the Prudential which appears to cover them. [/SIZE][/FONT][/SIZE][/FONT]

My first thoughts are that we should have spent our monthly premiums paying 3 income protection plans and not critical illness. We don't have the benefit of mortgage protection or income protection. We have raised a complaint with the Financial Services Ombudsman as my husband understood that he had a income protection plan. Its a long story but I was advised as a public sector worker that I shoudn't need income protection. My husband also declined at first but then thought better of it later. He Was advised to amend the key features document rather than a new one being issued, we cancelled our building and contents with them but he thought he added income protection. However, I don't think there is a case because they will have just said the premiums needed to be paid. However, my husband thought that the amount being paid out on critical illness each month accounted for income protection too.

My husband looks unlikely to be able to return to work and if ever not to the high pressured job in catering, long hours etc he had. He also has to be careful with his diet now so food tastings etc would be a problem. I will fill out the claim form because I understand they look at your own occupation prior to the illness but I am not hopeful although my husband remains optimistic. Hopefully, it is this optimism that will get us through.

Thanks again for all of you who have taken the time to respond and provide help in this case. Suzanne7173:T
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[FONT=arial, verdana][SIZE=-1][FONT=arial,verdana][SIZE=-1]Critical Illnesses[/SIZE][/FONT] [/SIZE][/FONT]
[FONT=arial, verdana][SIZE=-1][FONT=arial,verdana][SIZE=-1]We can always hope that we remain healthy for the rest of our lives. However, our health condition is one of the uncertainties that we have to face in life. And should we be stricken with a serious illness, the financial impact on our family's lives would be dire. 34 critical illnesses covered in by PRUcrisis cover and PRUcrisis cover plus are:

1. Heart attack: the death of a portion of a heart muscle as a result of inadequate blood supply to the relevant area as evidenced by an episode of typical chest pain, new electrocardiographic changes and by elevation of cardiac enzymes.
2. Surgery of the coronary artery: surgery of the heart as an attempt to correct blocking or narrowing/tightening of one or more coronary artery/ies by means of bypass grafts.
3. Stroke: cerebrovascular accident resulting in damage lasting for more than 24 hours; and including infarction of the brain, hemorrhage or embolism caused by extra-cranial origins; and subject to evidence of permanent neurologist deficit.
4. Cancer: malignant tumor characterized by uncontrolled growth of cells and the spread of malignant cell to/affecting other body tissues. This includes the medically uncontrollable development of diseases such as leukaemia and Hodgkins disease.
5. Kidney failure: terminal kidney failure resulting in systematic peritoneal dialisis or haemodialisis or transplantation of kidney of the person insured.
6. Transplantation of major organs: the person insured is a recipient of a previously conducted transplantation of major organs such as: heart, lungs, liver, pancreas or bone marrow; or the recipient is registered in a waiting list as a future recipient in the jurisdiction of the Republic of Indonesia.
7. Heart valve surgery: open-heart surgery as an attempt to correct or replace abnormal function of heart valve.
8. Loss of ability to speak: total and permanent loss of the ability to speak.
9. Burns: third degree burns on minimally 20% of body surface.
10. Coma: coma resulting in inability to react to external or internal stimulation lasting for minimum 96 hours.
11. Surgery of aorta: surgery performed as an attempt to correct deficit of aorta thoracalis or aorta abdominalis.
12. Parkinson's disease: Idiophatic Parkinson is a disease resulting from unknown causes that requires special care and assistance in the patient's daily activities. Diagnose of this disease has to be made by a neurologist. If required, the company will appoint one or more physicians specializing in neurology to back-up/support this diagnose.
13. Loss of hearing: untreatable total loss of hearing of both ears.
14. Alzheimer's disease: total paralyzation of the function of the brain resulting in mental deterioration and requiring continuous surveillance/care. A diagnose of this disease has to be made by a neurologist. If required, the company has the right to appoint one or more physicians specializing in neurology to back-up/support this diagnose.
15. Benign tumor of the brain: a brain tumor, which does not show signs of malignance, does not attack or expand to other regions/parts of the body.
16. Chronic disease of the lungs: the terminal stage of lung disease, which requires permanent use of oxygen.
17. Motor neuron disease: a functional deterioration of the central nerve-system to control muscular activity/ies resulting in the weakening or deterioration of the muscles' ability to move. Diagnosis has to be made by a neurologist. If required, the company is entitled to appoint other neurologists to support the diagnosis.
18. Multiple Sclerosis: is the occurrence of more than one episode of permanent neurological deficits in the course of 6 months. A neurologist, based on the results of image scanning, should confirm diagnosis.
19. Angioplasty and other invasive procedures for Coronary Heart Disease: the actual undergoing of balloon angioplasty, laser relief or other techniques to correct significant stenosis of at least 70% of two or more coronary arteries as considered medically necessary by a consultant cardiologist.
20. Aplastic Anemia: irreversible bone marrow failure resulting in anaemia, neutropenia and thrombocytopenia. The diagnosis must be based on a bone marrow biopsy and blood count test.
21. Bacterial Meningitis: is an inflammation of the membranes covering the brain or spinal cord caused by bacteria. The disease must result in permanent neurological deficit resulting in the total inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 Activities of Daily Living*) for a continuous period of at least 6 months.
22. Colitis Ulcerative: Ulcerative Colitis shall mean acute Fulminant Ulcerative Colitis with life threatening electrolyte disturbances usually associated with intestinal distention and a risk of intestinal rupture, involving the entire colon with severe bloody diarrhea. Diagnosis must be based on histopathological features and surgery in the form of colectomy and ileostomy should form part of the treatment.
23. Disabling Primary Pulmonary Hypertension: is the pathological increase of pulmonary pressure due to structural, functional or circulatory disturbances of the lung leading to right ventricular enlargement.
24. Encephalitis: is an inflammation of the brain (cerebral hemisphere, brainstem or cerebellum). The disease must result in significant complications lasting at least 6 weeks, which include permanent neurological deficit. The neurological deficit must result in the total inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 Activities of Daily Living *) for a continuous period of at least 6 months.
25. Fulminant Viral Hepatitis: a submassive to massive necrosis of the liver by a Hepatitis virus, leading precipitously to liver failure.
26. Chronic Liver Disease: end stage liver failure with increasing jaundice that in general medical opinion will not improve in future and resulting in either ascites or encephalopathy.
27. Chron's Disease: is marked by chronic inflammation of the colon. Crohn's disease will wax and wane in severity. Many patients develop diarrhea as well as abdominal pain and weight loss. Crohn's Disease is a chronic granulomatous inflammatory disease. The disease must result in fistula formation, or intestinal obstruction or intestinal perforation. The characteristic histopathological features must confirm diagnosis.
28. HIV from Blood Transfusion: the Life Insured being infected by Human Immunodeficiency Virus provided that:
    • the infection is due to a blood transfusion received after the Risk Commencement Date and
    • the source of the infection is established to be from the Institution that provided the blood transfusion and the Institution is able to trace the origin of the HIV tainted blood and
    • the infected Life Insured is not a haemophiliac.
29. Serious Head Trauma: accidental head injury caused by an external physical force resulting in neurological deficit causing the total inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living*)" for a continuous period of at least 6 months.
30. Muscular Dystrophy: are a group of degenerative myopathies caused by genetic disorder and characterised by weakness and atrophy of muscle without involvement of the nervous system. Claims shall only be admitted if Muscular Dystrophy causes disability resulting in the total inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living*)" for a continuous period of at least 6 months.
31. Serious Coronary Artery Disease: the narrowing of the lumen of at least one coronary artery by a minimum of 75% and of two others by a minimum of 60%, as proven by coronary arteriography, regardless of whether or not any form of coronary artery surgery has been performed. Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right coronary artery.
32. Paralysis: means the permanent and total loss of function of two or more limbs as a result of injury to, or disease of the spinal cord. Limb is defined as the complete arm or the complete leg.
33. Poliomyelitis: unequivocal diagnosis of infection with the polio virus leading to paralytic disease as evidenced by impaired motor function or respiratory weakness and resulting in the total inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living*)" for a continuous period of at least 6 months.
34. Systemic Lupus Erythematosus: a multisystem, multifactorial, autoimmune disorder which mostly affects females in their childbearing years and is characterised by the development of auto-antibodies directed against various self-antigens. In respect of this contract, systematic lupus erythematosus will be restricted to those forms of systematic lupus erythematosus which involve the kidneys (Type III to Type V Lupus nephritis, established by renal biopsy, and in accordance with the WHO classification). The final diagnosis may have to be supported by a certified doctor specialising in Rheumatology and Immunology.

[/SIZE][/FONT][FONT=arial,verdana][SIZE=-1]*) Activities of Daily Living: [/SIZE][/FONT][/SIZE][/FONT]

pedro123456

People with this condition, (even if their IC's cover it) and all the other CI conditions have to meet the IC's definition not the Dr's diagnosis, and that’s my point.

Read what I "actually" said.

Am In wrong?


Z

dunstonh

I wish they were all standerdised. If you go to a broker and they are tied to Legal & General then you don't have any choice and it was at a time when getting a mortgage was becoming difficult.

This is one of a few risks of using a tied agent. They only sell you what they have available. Usually its more expensive and often cut down versions of the IFA product.

OshayAway

It doesn't look like PruProtect cover Ulcerative Colitis under their Serious Illness Cover anyway . A list of the conditions are shown here: https://www.pruprotect.co.uk/documents/With_our_SIC_more_likely_payout.pdf

No mention of UC however there are a couple of associated conditions that it could pay out on depending on the effect of the condition for example:

• Permanent Faecal Incontinence
• Total Colectomy
• Permanent Rectal Fistalar

Bear in mind though that these would be paid out on a severity basis as a percentage of the sum assured. For example, if a claim was made on the 3rd condition listed, there would be a payout of 10% of the total benefit chosen.