Dump the critical illness?

kingstreet

I recently conducted some comparisons between different providers to see how their CI definitions varied and how the definitions had changed over time.

As Scottish Provident freely publishes this information, I set out here their changing definitions of "heart attack", later "heart attack of specified severity."

February 1996

The death of a portion of heart muscle as a result of
inadequate blood supply as evidenced by an episode of
typical chest pain, new electrocardiograph changes and by
elevation of cardiac enzymes

July 1999

Damage to any part of the heart muscle as a result
of inadequate blood supply as evidenced by new
electrocardiographic changes and by elevation of cardiac
enzymes typical of a heart attack. (No requirement of typical
chest pain.)

June 2000

The death of a portion of the heart muscle as a result
of inadequate blood supply as evidenced by new
electrocardiograph changes and by elevation of cardiac
enzymes. The evidence must be consistent with the
diagnosis of heart attack

September 2002

The death of a portion of heart muscle, due to inadequate
blood supply, that has resulted in all of the following
evidence of acute myocardial infarction: new characteristic
electrocardiographic changes; the characteristic rise of
cardiac enzymes, troponins or other biochemical markers;
where all of the above shows a definite acute myocardial
infarction. Other acute coronary syndromes, including but
not limited to angina, are not covered under this definition.

April 2007

Death of heart muscle, due to inadequate blood supply,
that has resulted in all of the following evidence of acute
myocardial infarction:
• New characteristic electrocardiographic changes;
• The characteristic rise of cardiac enzymes or Troponins
recorded at the following levels or higher:
– Troponin T>1.0 ng/ml
– AccuTnl > 0.5 ng/ml or equivalent threshold with other
Troponin 1 methods.
The evidence must show a definite acute myocardial
infarction.
For the above definition, the following are not covered:
• other acute coronary syndromes including but not limited
to angina.

OshayAway

Thanks Kinstreet, that's pretty clear I'd say.

However, unlike SP, most CIC providers added the requirement of the presence associated "typical chest pain" around 2003, therefore would not payout on silent heart attacks. Many have more recently removed this requirement thus improving the definition to make a decline less likely. At least one other provider is removing this exclusion in the next few weeks.

kingstreet

I've just had a look at theirs, and the AXA def is exactly the same as Scot Prov.

pedro123456

Thank you Kingstreet, could you please explain what this part of the latest definition implies to you.

" resulted in all of the following evidence"

ps I think you will find the definitions are bog standard as recommended by the ABI

kingstreet

pedro123456 wrote: »

Thank you Kingstreet, could you please explain what this part of the latest definition implies to you.

" resulted in all of the following evidence"

I would interpret that as saying a claim would only be payable if there are both ECG changes which can only be attributed to this event and above qualifying-level increases in troponin levels.

It does seem to leave a question mark over the "definite acute myocardial infarction" though. This surely requires opinion?

OshayAway

pedro123456 wrote: »

ps I think you will find the definitions are bog standard as recommended by the ABI

No, it's not, this is an ABI+ (PLUS) definition. Did you misunderstand my post or just not believe me?

The "bog standard" or Model" definition as recommended by the ABI allows for heart attacks without "typical chest pain" not to qualify for payout. As you can see from kingstreet's list of SP definitions, never has this clause been added.

pedro123456

Thanks Kingstreet

So if a Cardiologist diagnoses a heart attack by raised troponins alone, and after all he is the expert, how come the ABI can suggest its own definition of a heart attack for the IC to use?

The consumer has no idea of definitions, all they know (or all they think they know) is if they have a heart attack they are covered by their CI cover, because thats what they were told by the IC at the time. only to be told when submitting a claim "well just because your Doctor or Cardiologist say you have had a heart attack, i'm afraid you haven't met our definition".

OshayAway, lets forget the naming, just post a definition that is less likely to lead to a better outcome for a claimant.

pedro123456

"No, it's not, this is an ABI+ (PLUS) definition".

Have you ever thought of doing stand up comedy OshayAway, is this plus definition akin to go faster stripes on cars?

OshayAway

pedro123456 wrote: »

Thanks Kingstreet

So if a Cardiologist diagnoses a heart attack by raised troponins alone, and after all he is the expert, how come the ABI can suggest its own definition of a heart attack for the IC to use?

The consumer has no idea of definitions, all they know (or all they think they know) is if they have a heart attack they are covered by their CI cover, because thats what they were told by the IC at the time. only to be told when submitting a claim "well just because your Doctor or Cardiologist say you have had a heart attack, i'm afraid you haven't met our definition".

OshayAway, lets forget the naming, just post a definition that is less likely to lead to a better outcome for a claimant.

This is just one example of variations within critical illness plans. I don't see the point of dissecting a single condition, it won't change the facts.

The facts are that some critical illness plans are more comprehensive than others. All of this is set out in the policy document and other literature available prior to the purchase of the policy.

A good adviser should point out at least some of these variations but in reality we are talking about one condition (out of 40+) so is it reasonable to go through in excess of 20 documents for each condition to compare? All of them fulfill the minimum "model" definitions.

pedro123456

OshayAway, yes it is only one example, but I will say it again, definition by the IC for the IC, this definition takes all medical definitions and lumps them all together, and how that is a positive/fairer/clearer move baffles me.

No doubt most if not all the other definitions will be the same, unless you of course can tell us otherwise.