Critical Illness Insurance

GSMAnon

Hi all,

Just wondering if anybody has experience of Critical Illness Insurance and might know how long it generally takes between submitting a claim and receiving a payout?

It says on our policy that it could take anywhere up to 6 months, and I'm sure it varies case by case, but I'm just interested to know what people's general experiences are... is it often as long as 6 months, or do the payments tend to come through relatively quickly if the verification of all details goes through smoothly?

Wutang_2

usually smoooooothly

GSMAnon

Wutang wrote: »

usually smoooooothly

Err... what?

ACG

The main delay with any payout is waiting on the Drs or surgeons notes.

Ive seen payouts within a month and had others that have taken about 3-4 ive never seen 6 months but i can believe it probably happens with some surgeons.

kingstreet

It'll depend on the condition. An issue like multiple sclerosis will typically require a period of continuing symptoms.

For example;-

A definite diagnosis of Multiple sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

Whereas;-

The undergoing of surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.

affixes no time requirement on a claim for coronary artery bypass grafts

GSMAnon

kingstreet wrote: »

It'll depend on the condition. An issue like multiple sclerosis will typically require a period of continuing symptoms.

For example;-


Whereas;-


affixes no time requirement on a claim for coronary artery bypass grafts

In this case it's a heart attack and minimally invasive surgery to repair an abnormal heart valve.

Done, dusted, and already diagnosed clearly by the Docs.

kingstreet

If it's a fairly recent plan, say upto five years old, the definition of heart attack commonly used is;-

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.

Provided this criteria is met and confirmed by the Consultant Cardiologist, I can't see any reason why a claim shouldn't be settled quickly.

Can you check the definition being used?

GSMAnon

kingstreet wrote: »

If it's a fairly recent plan, say upto five years old, the definition of heart attack commonly used is;-



Provided this criteria is met and confirmed by the Consultant Cardiologist, I can't see any reason why a claim shouldn't be settled quickly.

Can you check the definition being used?

The definition being used is:

Heart Attack

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

And:

Keyhole Heart Surgery

Undergoing from medical necessity:

• minimally invasive surgery to replace or repair an abnormal heart valve

• surgery (including minimally invasive and open heart surgery) to repair the heart wall damaged by coronary artery disease, or

• surgery (including minimally invasive and open heart surgery) to correct any narrowing, dissection or aneurysm of the thoracic or abdominal aorta.

The patient in question did suffer a heart attack, and I'm sure the appropriate tests (ECG, enzyme monitoring) will have been carried out to the confirm this, and keyhole surgery was then performed to place two coronary stents into the coronary arteries to treat the narrowing of those arteries.

Please note, there are two policies for this person. One relatively recent, and one from more than 10 years ago... the definitions given are for the one from 10 years ago.

Do you think it likely that two critical illness policies for the same person will be paid out?

shirlgirl2004

For my brother's clearcut case it was a couple of months.

starrystarry

GSMAnon wrote: »

The patient in question did suffer a heart attack, and I'm sure the appropriate tests (ECG, enzyme monitoring) will have been carried out to the confirm this, and keyhole surgery was then performed to place two coronary stents into the coronary arteries to treat the narrowing of those arteries.

This may well fit the definition of "heart attack" as quoted above, but it won't fit the definition of "keyhole heart surgery". That definition covers valve repairs/replacements, heart wall repair and narrowing/dissection/aneurysm of the thoracic or abdominal aorta (coronary stenting is not one of these).

GSMAnon

starrystarry wrote: »

This may well fit the definition of "heart attack" as quoted above, but it won't fit the definition of "keyhole heart surgery". That definition covers valve repairs/replacements, heart wall repair and narrowing/dissection/aneurysm of the thoracic or abdominal aorta (coronary stenting is not one of these).

Ok, how about this... just found it lurking in the Standard Provisions of the protection plan...:

Angioplasty (2 or more arteries)

Undergoing on 2 or more coronary arteries:

• balloon angioplasty,
• atherectomy,
• rotoblation,
• laser treatment, or
• the application of stents for coronary heart disease.

There must be an angiographic or equivalent evidence of the underlying disease, which shows there is a stensis of at least 50% narrowing of 2 or more coronary arteries. The disease must be considered uncontrollable by non-invasive medical therapy.

I don't know precisely how much narrowing there was by percentage, but two stents were applied to two arteries by angioplasty. Surely they wouldn't have applied the stents without considerable narrowing? And clearly they thought it was uncontrollable ny non-invasive therapy, or they'd have opted for alternative treatment first. Instead, the stents were applied within hours of the diagnosis... which leads me to doubt that they considered or tried an alternative.