Critical illness policy ended

panacotta

Hello I'm a newbie so please excuse any errors I make here.

I need some advice about a CI policy we held for twenty years that ended eight months ago.
Since then my partner has been diagnosed with blocked arteries that requires heart by pass surgery.
He started with chest symptoms five years ago and went see his GP who put it down to stress and did not send him for any tests.
The cardiologist said it is highly likely these symptoms are linked to his blocked arteries.
My question to the forum is can you ask the insurer if they will consider treating the illness as diagnosed before the policy ended.
Or is there anything else we can do?

DullGreyGuy

Read the policy wording both in terms of claim eligibility in general and for his condition explicitly. 

The wording for the couple of policies I have on my laptop requires the diagnosis to have occurred whilst the policy is active. If the diagnosis is post termination of the policy then there is no claim even if the doctor states that the condition would have been present whilst the policy was still in force. 

Blocked arteries in themselves wouldn't meet the definition of critical illness in them either. Either need to require open chest surgery (many things are done by keyhole these days) or significant damage to the heart at level 3 of the NY Heart Association scale of failure... ie chest pains, out of breath etc for doing just normal day to day activity like getting out of a chair or walking at a slow pace

panacotta

Thanks.  I will read the policy as you suggest but if two of the policies on your laptop say the same then its probably a case of bad timing.
My partner has too many blockages for stents and requires a heart bypass performed through open heart surgery.
Would that satisfy the NY scale of failure if the diagnosis occurred when the policy was active?

DullGreyGuy

panacotta said:

Thanks.  I will read the policy as you suggest but if two of the policies on your laptop say the same then its probably a case of bad timing.
My partner has too many blockages for stents and requires a heart bypass performed through open heart surgery.
Would that satisfy the NY scale of failure if the diagnosis occurred when the policy was active?

Each policy is different but surgery on the heart which requires a median break of the sternum is a common "illness" in its own right. 

The NY Heart Association Scale is used for those where parts of their heart have thickened/stiffened/died, there is no surgical solution other than a transplant in most cases... so as a condition you're going to have to live with they use the scale to measure how badly its impacting you. It goes from 1 elevated risk to 4 heart failure

panacotta

Can I ask is the NY scale used by insurers to determine a CI claim?

DullGreyGuy

panacotta said:

Can I ask is the NY scale used by insurers to determine a CI claim?

Its fairly common in the condition of cardiomyopathy, its not used for other conditions.

Whereas you buy insurance to protect you against the risk of illness your insurer in turn buys reinsurance to protect them from a significant increase in morbidity. It's fairly common for the reinsurers to have a hand in defining the illnesses and their severity and given there arent that many reinsurers and insurers dont want all their eggs in one basket its why you see a reasonably consistent set of conditions and severities.