Rejected critical illness claim

Mollychico

I'm 39 years old and Director of small business and suffered a Subarachnoid haemorrhage in Nov 2013. Critical illness claim rejected very quickly and still not able to work. Insurer asked very limited/ minimal questions of my GP and consultant. I've asked insurer to reassess but any advice on how to progress would be really helpful.
I feel as though policy was a waste of money for last 8 years!
Thought I was being financially astute but the "paying out" as you're told by FA is not quite so simple and the financial stress I'm under has certainly not helped my recovery!

Same insurer is taking months to make a decision on an income protection policy too - overall very disappointed.

antrobus

Mollychico wrote: »

I'm 39 years old and Director of small business and suffered a Subarachnoid haemorrhage in Nov 2013. Critical illness claim rejected very quickly and still not able to work. Insurer asked very limited/ minimal questions of my GP and consultant. I've asked insurer to reassess but any advice on how to progress would be really helpful.
.....

As far as I'm aware a 'critical illness' policy is one that pays out if the insured is a diagnosed with a specified life-threatening condition. Whether or not a claim based on suffering a subarachnoid haemorrhage is valid would depend on whether the relevant policy included that as a 'critical illness'. Either it does or it doesn't.

dunstonh

Often with this event, there has to result in permanent neurological deficit.

Her is an example of when it is/is not covered: (copied and pasted). - not different companies may have different definitions. CI polices are not all the same.

Stroke – resulting in permanent symptoms

Plan definition

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms*. A diagnosis of subarachnoid haemorrhage resulting in permanent neurological deficit with persisting clinical symptoms*, supported by CT or MRI evidence, is covered under this definition.

For the above definition, the following are not covered:
• Transient ischaemic attack.
• Traumatic injury to brain tissue or blood vessels.

*"permanent neurological deficit with persisting clinical symptoms" is clearly defined as:
-• Symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the insured person's life.
• Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia(inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty inwalking, lack of coordination, tremor, seizures, dementia, delirium and coma.

The following are not covered:-
• An abnormality seen on brain or other scans without definite related clinical symptoms
• Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms

In simpler terms
The brain controls all the functions of the body. Damage to the brain can have serious effects. A stroke happens when there is severe damage to the brain caused by internal bleeding (haemorrhage) or when the flow of blood in an artery has been blocked by apiece of tissue or a blood clot (a thrombus or embolus) resulting in the brain being starved of oxygen.This benefit does not cover ‘transient ischaemic attacks’ (also known as mini strokes orTIAs), where there is a short-term interruption of the blood supply to part of the brain.The main symptoms of TIAs tend to be dizziness and temporary weakness or loss ofsensation in part of the body or face.

Pre-existing conditions
If you have ever suffered from a heart attack or stroke or undergone coronary artery surgery, angioplasty or heart transplant prior to the commencement date of cover youcan never claim under heart attack, coronary artery bypass grafts, major organ transplant or stroke. If you have a history of intracranial aneurysm, atrial fibrillation, coronary artery disease,diabetes mellitus, peripheral vascular disease, hypercholesterolaemia, transient cerebralischaemia, hypertension, arteriovenous malformation, thrombotic disorders e.g., primaryphospholipid syndrome, hyperviscosity states (polycythaemia), heart valve disease andcarotid atherosclerosis prior to the commencement date of cover and you suffer a stroke

magpiecottage

Mollychico wrote: »

Same insurer is taking months to make a decision on an income protection policy too - overall very disappointed.

Income protection should pay out from the end of the specified waiting period. If that has expired and you are not receiving payments you seem to have grounds for complaint.

InsideInsurance

What have been the stated reasons for excluding the CI claim?