Recent press coverage has again lambasted the insurance industry over critical illness insurance. The underlying problem is that a critical illness claim is not as straightforward as, for example, a claim under car or life insurance. With car insurance it's patently clear whether or not you've had an accident - the damage is there to be seen and repaired. And with life insurance it's going to be hard for the insurer to argue that you're not dead!

By their very nature, critical illness claims are far more complicated. The insurers will need to satisfy itself that the claim is valid in three primary areas before it pays out: -

Is the medical diagnosis correct?

Is the diagnosed illness included in the schedule of insured critical illnesses listed within the policy documents?

Did the policyholder fully disclose their state of health and medical history on their original application form?

It's clearly in the policyholder's interest to check that the medical diagnosis is correct - so there's rarely ever any conflict between the policyholder and the insurance company on that issue. It's the other two areas which require validation where conflicts sometimes arise.

With constant research and development in the medical field there can sometimes be some illnesses where validation falls into a grey area