Declined Critical insurance Claims

Appealing Rejected Critical Illness Insurance Claims

If you have been diagnosed with a serious medical condition like a heart attack, stroke or cancer you may have tried to claim on your Critical Illness Cover. Having to live with a serious medical condition should mean that your sole focus should be on your health and getting better.

What is Critical Illness Cover?

Critical Illness Insurance will normally pay-out should you be diagnosed with a condition (listed in the policy). This covers things such as cancer, heart attacks and strokes along with other serious medical conditions. Critical Illness may be a stand-alone policy but is often sold alongside Life Insurance.

Different Types of Cover?

They are a few slightly different types of Critical Illness cover (the below list is the most popular but not an exhaustive list):

• Term assurance. This is often taken out to cover an asset or debt (for example a mortgage). The term is fixed at the outset and will either decrease as times goes on (Decreasing term assurance), stay the same (Level term assurance) or increase (Increasing term assurance).
• Serious Illness cover. This is slightly different to Critical Illness Insurance where it pays out on the severity of your conditions. For example, if you had a grade 1, stage 1 type cancer you might receive 25% of the sum insured, whereas if you had stage 4 lung cancer, you may receive 100% of the sum insured.

There are also slightly different policies that may be called ‘family protection plans’ which involve paying an income (not income protection) instead of a lump sum. You may also have Total Permanent Disability cover. See more on this here.

Why are Claims Rejected?

According to the Association of British Insurers (ABI) there were 18,450 claims made against policies in 2020. Just under 10% of these claims were unsuccessful, resulting in £107,562,707 worth of claims being declined. That’s over 2 million pounds per week or nearly 300 thousand pounds every single day.

Critical Illness Claims can be rejected broadly for two main reasons:

Non-Disclosure. This is the most common reason in declining a Critical Illness claim, where an insurance company will suggest that you should have disclosed certain medical or lifestyle information when you applied for the policy. Insurance companies must abide by strict rules when declining claims due to non-disclosure and can often interpret information in the way that would most likely lead to a claim being declined. Have a look at some of our case studies for more information.

Not meeting policy definitions. You may have heard of some insurance companies saying that ‘the cancer wasn’t advanced enough’ or ‘it was the wrong type of heart attack.’ We have had several successful cases where an insurance company has used outdated medical information when rejecting Critical Illness claims. Again, insurance companies can often look at evidence that favours a claim being declined rather than being fair and reasonable.

What Can I Do?

You can always make a complaint yourself, free of charge, to your financial service provider or the Financial Ombudsman Service. You may also search on the internet for “insurance claim solicitor” or “insurance complaint company”.

When appealing a rejected Critical Illness insurance claim, it’s important to take an evidenced based approach. At Resolute Claims we have specialists who have extensive knowledge in helping people overturn rejected Critical Illness insurance claims.

We have already helped customers successfully appeal their rejected Critical Illness Insurance claim. You can visit our case study section of our website to see how we’ve helped.

How Can Resolute Claims Help?

Resolute Claims can provide free information and support if you feel let down by your insurance provider. When you call us, you will be assigned an expert in that area of insurance. We will be able to provide you with free help and guidance in helping you to make a claim. We can even write to your insurance company and provide you with our opinion and the likelihood of success.

If you decide to use our service, you will be formally assigned a case manager. Your case manager will specialise in appealing Critical Illness insurance claims and have extensive knowledge of the processes involved in making a successful claim.

We will investigate the claim which normally involves looking at the policy terms, medical information and precedent cases.

If you would like more information, you can call us on 0333 050 8792, start a webchat below or book an appointment here.