Critical Illness reject claim

Not uncommon for claims to be deferred in these circumstances. I!!!8217;d expect they!!!8217;d want to review it in 6 months or so.

Is he having any ongoing treatment or rehabilitation from other NHS services? Your GP may be able to provide evidence of this to the insurer.

If he really does not receive any follow up from a neurology clinic, the insurer may be willing to fund an independent examination by a neurologist. This would be purely for the purpose of assessing the claim, not advising on treatment.

sheramber wrote: »

The strike definition does not mean there is cover. It is merely explaining what a stroke is.

The policy only covers permanent disability and the last paragraph applies

For more information on what we mean
by permanent and neurological deficit with
persisting clinical symptoms, please see page 41.

Unless there was a specific exclusion for stroke (unlikely) then stroke will be covered as CI plans aren't modular. You are either covered for all the conditions or not. The actual definition for a stroke is as follows:

Definition
Death of brain tissue due to inadequate
blood supply or haemorrhage within the
skull resulting in all of the following:
• definite evidence of death of tissue or
haemorrhage on a brain scan; and
• neurological deficit with persisting
clinical symptoms lasting at least 24
hours.
For the above definition, the following is not
covered:
• transient ischaemic attack
• death of tissue of the optic nerve or
retina/eye stroke

There is no mention for it needing to be permanent these days, however, if you read the definition for "spinal stroke" you will see the definition states permanent neurological deficit. If the word permanent isn't in the definition then permanent symptoms aren't needed.

HOWEVER, as I previously stated, it's unlikely that's the case on an older plan as permanent symptoms were often required meaning that a waiting period before a claim could be made would often occur. Unfortunately, this isn't unusual and I'd still be hoping for a positive outcome, albeit it potentially in a few months.

Best of luck and a quick recovery for your husband. Based on all the info you've provided I'd be very surprised if it didn't result in a valid claim. Fingers crossed it's resolved speedily and in a stress free manner.