Certain claims and facts
The average claim amount paid is around £79,000.
The most critical illnesses that are ranked according to claim volume are:
Cancer
Heart attack
Stroke
Multiple Sclerosis
Benign brain tumor
The median age of claimants has been set at 45 (for males) and 43 (for females).
Receiving the news from your doctor can be an emotional time for your family and you however, your critical illness insurance could be a strong foundation you can rely on. Particularly when you know you are able to file an application and get a reimbursement to cover the costs associated with the treatment.
Click here for help claiming on critical illness insurance.
Based on the claims reports issued by major insurers, the amount of claims that are paid varies from 91 percent to 98 percent. A key element to an effective critical illness claim is submitting the claim correctly.
Here are a few simple rules and guidelines you should to keep in mind when submitting a claim:
Do:
Give full disclosure. While it’s not too late to do this, it’s important to remember that you have to disclose your current health situation at the time of the application. In the event of a delay, it could result in having your claim for critical illness denied.
What details do I have to include when making an claim for critical illness?
Here are the documents you will need to submit:
Completed claims form.
The medical report of your doctor. Most doctors are working within an “approved” country and be an expert on the condition being treated.
Diagnostic and laboratory reports.
Contact information and personal details.
Get documentation. It is recommended to keep all medical documents. You’ll need to provide them when you file an application.
Inform your insurance provider at the earliest opportunity. When you’re diagnosed with a medical condition which is covered under your insurance policy, you must to notify your insurance company about the condition immediately. This way, you’ll be able to start the process and get the claim process can begin. This will ensure that you receive your claim sooner and are aware of the documents you’ll need to file your claim.
To ensure the timeliness of your claims, it is important to be aware of the dates in your policy.
Prepare to file an appeal in the event that your claim is rejected. If your claim is rejected, you are able to make an appeal. If your claim is denied on the beginning isn’t the end of the story for you. You can consult with the adjuster for insurance claims to determine the additional details needed to support your claim.
Don’t:
The most common reason for denial of claims is because they do not meet the policies definitions:
Heart attack. Certain heart problems can be misinterpreted as a heart attack, when in fact it’s not.
Stroke. Ischaemic attacks that are transient can be similar to the signs of a stroke , but the recovery usually occurs in less than 24 hours. They are not covered by the policy.
Coronary angioplasty. The claims can be rejected for coronary angioplasty when there is less narrowing than 70 percent in two or more arteries.
Bladder cancer of the bladder. If it is detected early, it can be treated and is not invasive.
Consider that you’re protected. It is crucial to understand the exact coverage of your insurance. There could be different definitions of an illness covered therefore you must determine under what circumstances the illness is covered. Be aware that the insurance company will only pay if your claim is within the scope that is specified in the policy. If not then your claim could be rejected because it doesn’t meet the requirements.
For example, there are cancers that aren’t covered . For instance, some cancers that aren’t considered crucial and can be treated are not usually covered under the policy on critical illness. There could also be other conditions that apply to your age, the country from which you were diagnosed and more.
Complete the application form in case you are not sure of the information. If there’s an information regarding medical conditions on the claim form that you are not certain about, consult your physician first before you write any information down. Make sure you do not leave any gaps in the form – the insurance company may not consult with your physician to determine the gaps on your application form.
Inability to pay your premiums. This could be too late however, your inability to pay your premiums within the grace period could indicate that your policy is not in effect anymore. Additionally, you must keep paying your premiums until your claim is handled.
Do not make any false claims. First, your insurance provider will thoroughly examine the authenticity claims. If they discover that you made an untrue claim and they deny your claim. Additionally, they could “blacklist” you , and it could affect subsequent applications you make to insurance firms. There is also the possibility of being charged for fraudulent claims.
What are the main reasons certain serious diseases are not given an insurance coverage?
The condition being sought for is not covered by the insurance policy.
The condition does not fit the criteria set forth in the policy.
The disease is not covered. Learn more about exclusions in the article The Exclusions to your Critical Illness policy
The applicant provided incomplete or incorrect medical information which could have led to an application to be rejected or denied coverage.
Are you able to appeal if your claim is rejected?
If your claim is rejected If your claim is denied, you may still file an appeal first to your insurer , and later to an agency of the government. If you believe that your claim is a legitimate one, you may appeal to your insurance provider. It is important to provide the reasons for filing your appeal. If you have additional evidence in support of your claim, now is the right time to submit the evidence for review.
If, following the appeal and the claim is rejected, you may submit an appeal with the Financial Ombudsman Service.