I'm not sure if I'm eligible to make a critical illness insurance claim

Published 16 Aug 2016

Critical insurance cover, or trauma cover as it is also known, is an insurance product that sees the insured party and the insurer come to form an agreement, whereby a lump sum is paid should the insured suffer from a critical illness.

The industry for critical illness insurance is one that has grown exponentially in recent years, with most insurers now including it in their offering. The worry when it comes to making a claim against it, however, is that insurance companies will employ some underhanded tactics to avoid giving you the full amount you may be entitled to for a claim. Occasions such as this are why you need to seek the services of experts who have experience in dealing with critical illness insurance claims.

What constitutes a critical illness?

If you're unsure about the legitimacy of a potential claim, it's imperative you know what is covered under the policy that covers it. Critical illness can include, but is not exclusively:

  • Cancer
  • Heart attack
  • Parkinson's disease
  • Kidney failure
  • Stroke
  • Deafness
  • Blindness
  • Organ transplant
  • Multiple sclerosis
  • Coronary artery by-pass

The conditions covered varies depending on what insurer you are with and what policy you have. It is important to note, however, that self-inflicted injuries and extreme sports injuries are not covered. As it covers such a diverse range of categories, it's important to speak to your provider to know what is covered by your policy.

I know my condition is covered by my policy, but I feel I've been underpaid, what do I do?

Instances such as this can be very stressful ones which can leave you disheartened. In extreme cases being underpaid or having a claim dismissed outright can have dire consequences on your lifestyle. The timing of your claim is also important. Insurers will sometimes only provide cover if the condition occurs within three months of the policy beginning.

For any query regarding your critical illness policy, the team at Gerard Malouf and Partners' Superannuation Disputes is here to help. Our team has fought thousands of insurance claims over the course of our combined experience. Although we are successful in over 98 per cent of cases, we aren't interested in statistics.

We are interested in doing the best by our clients. We offer a unique service guarantee that shows how much we care about helping out clients. If you're in any doubt, get in touch and ask about our No Win No Fee policy we offer on all claims.

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