Appealing Critical Illness Cover, Declined Critical illness

With almost 1 in 10 critical illness cover claims being declined in the UK it's the most refused type of claim in the UK. 6 claims everyday are declined in the UK, that's 3 million pounds a day (107 million pounds a year). They're many reasons an insurance company might decline a critical illness claim but the overwhelming majority are due to 'not meeting the definition of the policy'.

This means the condition you've been diagnosed with has technically not met the description in the policy. This can often be a worrying time as the impacts are the same, if not identical, to conditions that do meet the definitions.

For example some insurance policies only payout if certain arteries are involved in a heart attack where others aren't, despite morbidity and mortality rates being roughly the same. Additionally, a lot of the time you can find insurance companies arguing over technicalities of conditions, certain types of cancer doesn't have enough Nodules or the differential in the cells doesn't meet the criteria.

It's a mine field at the best of times and one case comes to mind in particular. A customer who was diagnosed with a Sarcoma that was previously thought to be a skin cancer. The WHO and Sarcoma UK updated their guidance to reflect this fact, but the insurance company refused to accept it was a Sarcoma and stated it was a skin cancer. Why.....well. Most insurance companies only pay out for skin cancers if it's a malignant melanoma. When presented with evidence they said they would have to use information as it was when the policy was taken out.

We disputed this with them and took it to the Financial Ombudsman where we successfully received a payout for the customer. Furthermore the customer had already complained to FOS and was initially rejected before coming to ourselves.

The important thing to remember is that if it doesn't feel right, there's every chance it might not be.