Critical Illness Claim Statistics - 2009

OshayAway

There's really no need to be unpleasant Pedro, please don't resort to that again and get this thread deleted like you have with others. I'm sure it will be of interest to some.

It's not a complicated point I'm making. I'm simply stating that it is only right that specific definitions and criteria of claimable conditions exist for clarity, consistency and to avoid unnecessary speculation at claim.

A TIA (mini-stroke) for example is a type of stroke by it's very definition, but not critical. Hence it is (correctly so) excluded from stroke payouts. Without such criteria, someone could feel short-changed if they had been diagnosed by a consultant as suffering a ‘type’ of stroke, which they are not covered for.

Nicko67

Same applies with cancer. I have seen claims made for non-malignant moles, perhaps by chancers on the make or by policyholders who hadn't read their documents.

Eitherways it backs up Oshay's original point that CIC claims are invariably paid when they're genuine.

pedro123456

1000 pardons Oshay if you interpreted my last post as me being unpleasant, that was not my intention. :kisses3:

I understand what point you are making, yes we have to have clear definitions of conditions, I aint in disagreement there.
The GP/Consultants have medical definitions too you know, they make a diagnosis based on those definition don’t they?

I’m not sure if you are being evasive intentionally or inadvertently, anyway to try again.
We have established that the already GP/Consultant knows the difference between a TIA/mini stroke (as you call them) and has diagnosed a STROKE

So having “DIAGNOSED A STROKE HOW CAN THE INSURANCE COMPANY DISPUTE IT”…..Sorry for raising my voice, all I request is a simple answer (in your own time of course).

Is this is the first post you have started Oshay, if so well done, its been viewed 600+ times already, so yes I agree again, it must be of interest to others………..your answer is? :wall:

pedro123456

Same question to you then Nicko67, lets say a GP/consultant diagnoses you have cancer, not a non malignant mole but cancer, and a policy holder was sold and bought a policy on the understanding that if i got cancer (a core condition) , or any other core condition I would be covered.

That's how they are described at the point of sale, aren't they?

So if the GP/consultant diagnosed cancer, how can the IC dispute it?

OshayAway

Pedro, you must know the answer to your own question. Was your declined claim for a Stroke? If so you will know that the criteria is specified in the policy document or the supplied policy conditions booklet that pertains to your policy and specified with a reference.

Nicko67

pedro123456 wrote: »

Same question to you then Nicko67, lets say a GP/consultant diagnoses you have cancer, not a non malignant mole but cancer, and a policy holder was sold and bought a policy on the understanding that if i got cancer (a core condition) , or any other core condition I would be covered.

That's how they are described at the point of sale, aren't they?

So if the GP/consultant diagnosed cancer, how can the IC dispute it?

If a policyholder contracts a CI as specified in the policy document, (s)he will be covered. No mystery, sorry.
Regarding what happens at 'point of sale', an adviser would read through certain sections of the Key Features Document to ensure the client understands certain risks and procedures. The KFD, which includes a list and description of each CI would then be given to the customer, and they should be told that if they need clarity on medical definitions, a technical guide is available to them prior to the policy commencing, and that these specifics are included in the policy document. It would be churlish to suggest that an adviser should sit and read through the medical definitions of 2 / 3 / 4 dozen illnesses, but this can be done if a client has specific concerns about any of them at point of sale (e.g. due to family or personal health).

pedro123456

Oshay I do indeed know the answer to my question, lets talk in simple terms ,criteria and policy documents are all a little sneaky, the answer is this.

Although your Consultant and or GP may have made your diagnosis of a “critical illness” (this is based on medical criteria) .It can be denied because it doesn’t meet the IC’s own specific definition, a definition is based on ‘reduce pay out criteria’.

Nicko67, when an individual takes out CI cover, and as I said it is sold on the basis that its your safety net in case you should suffer health problems, such as the core conditions.
Do you really think they have any idea about criteria’s, medical definitions, technical guides? Because I don’t, that’s my opinion of course.
Do they have any initial concerns about family or personal health, maybe but of course if there was a concern for the IC, they would be declined cover.

IMO, this and a few other reasons are the under pinning causes of the public mistrust in the Insurance Industry, in that “what the public perceive they are paying for (peace of mind products), turn out after a claim to be full of loop holes, to avoid claims.

OshayAway

pedro123456 wrote: »

“what the public perceive they are paying for (peace of mind products), turn out after a claim to be full of loop holes, to avoid claims.

Yes, all 3 - 4% of them... shocking!

My experience is quite the opposite. I've never personally seen a CIC claim declined. On the other hand I have seen claims change lives and many who enquire about critical illness cover do so because they have seen a friend or family member benefit from a payout.

Anecdotally, I have met Dr Marius Barnard who assisted his brother in the first human to human heart transplant 40 years ago. He designed critical illness cover out of a desire to assist those who suffer a serious condition, providing financial support when it is needed the most. He still strongly believes in the product and actively promotes its value.

OshayAway

Legal & General have just released their 2009 Critical Illness claim statistics:

• 93.6% paid (£152 million)
• 1.8% Claims declined due to non disclosure (down from 4.2% in 2008)
• 4.6% Claims declined due to not meeting the policy definition

(source: http://www.legalandgeneralcomms.co.uk/downloads/5059%20Quick%20Stats%20Q26816%20D2.2.pdf )

It's good to see these figures increasing, as with other providers. I will post other insurance providers statistics as they become available.

Nicko67

L&G are not as far ahead as in previous years, although still (I think) the highest payout rate released so far. With Aviva, LV and Friends Prov still to come, it looks like a record year percentage-wise.