Critical Illness Insurance The main reason for rejecting a claim is non-disclosure
If you make a claim on a critical illness insurance policy your insurer will routinely make exhaustive enquiries about the history of your health. Whilst you’ll have provided them with lots of similar information when you first applied for the insurance, they’ll now insist that all the information is rechecked. And if you said you were not a smoker, they will also want this verified by your doctor.
The reason is clear. The insurer is faced with a big claim, typically well over £100,00, and they want to know that you told the full truth about your health when you applied. This means that now you’ve claimed, they’ll crawl through your medical records in great detail checking that you told them everything when you applied. Even the smallest and apparently insignificant detail will be subject to intense scrutiny. And this can be upsetting for you.
The insurers defend this process saying that they need to be sure that back when they accepted the business, the applicant told the full truth. They want to be sure that the applicant didn’t cheat by omitting some detail in order to dupe the insurer into issuing a policy when they otherwise wouldn’t have, or to qualify for a lower premium. Either way, omitting information would be cheating and grounds for refusing the claim.
The insurers are particularly suspicious if the claim arrives during the policy’s first five years. Any claim arising in this period is classified as an “early claim” and they’re particularly on the look out for any policyholders who took out the critical illness cover already suspecting that that they may be ill.
The problem is that this intense scrutiny attracts a very bad press. If you’ve just made a claim, you’re inevitably very sick and the last thing you want is lots of questions and high handed hassle from your insurer. There’s clearly a conflict here and the insurers need to work much harder at softening the presentation of the enquiry process and they must liase much more closely with their claimants. They must present a much softer centre.
