What are the criteria for making a critical illness claim?

Published 03 Mar 2015

Receiving news that a family member has been diagnosed with a critical illness is devastating, particularly if it is a terminal disease. Critical illnesses often require specialist treatment, can lead to time off work and may result in the need for significant lifestyle changes.

Therefore, it's probably not surprising that families may find themselves in financial difficulty when a loved one becomes sick. Critical illness insurance - or trauma insurance as it is sometimes known - can help alleviate the monetary burden, bringing peace of mind and stability to the insured party.

However, how do you know whether or not you are eligible to make a critical illness claim? And what are the criteria that must be met in order to pursue a payout? Read on to learn more about these insurance products.

Am I covered for a critical illness?

There are numerous insurance options on the market, encompassing a wide range of situations. Here are just some of the conditions that are included in policies:

  • Cancer
  • Heart attacks and cardiac surgeries
  • Multiple sclerosis
  • AIDS and HIV
  • Liver and kidney failure
  • Motor neurone diseases
  • Multiple organ failure
  • Paralysis

However, this is far from a comprehensive list, so it is important to check the details of specific insurance products to see if it covers the illnesses you are most concerned about. Typically, self-inflicted harm and serious sports-related injuries are not included in these types of policies.

In the event you are diagnosed with a disease or ailment included in your policy, you should receive a lump sum payment to ease any financial strain and give you the freedom to reduce work hours if you wish.

What do I do if my claim is rejected?

Your critical illness claim could be rejected for a number of reasons. For example, some policies enforce time limits that prevent you from receiving a payment if you are diagnosed soon after signing the document.

There are other exclusions that may allow the insurance company to reject your case, so make sure to check the small print carefully. In some circumstances, you could be approved but receive less money than you're entitled to.

If you are unhappy with the payment you have been allocated following the diagnosis of a critical illness, contact our expert legal team to fight your corner. No-win, no-fee representation eliminates the risk of you losing out financially should your case not be successful.

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