Critical Illness Insurance - The Press Are Giving Insurers A
Hard Time.
Recent stories in the press have again lambasted the insurers
over critical illness insurance. The core problem is that a
critical illness claim is not as straightforward as, for
example, a claim under life insurance. With life insurance it's
going to be hard for the insurance company to argue that you're
not dead!
By their very nature, critical illness claims are much more
complicated. The insurer will need to satisfy itself that the
claim is validated in three key areas before it meets the claim:
-
Has the illness been correctly diagnosed?
Is the confirmed illness included in the schedule of insured
critical illnesses covered by the policy?
Did the policyholder fully disclose their medical history and
current state of health on their original application form?
On the first point, it's obviously in the policyholder's
interest to verify the medical diagnosis - so there's rarely
ever any conflict between the insurance company and the
policyholder on that issue. It's the next two areas which the
insurer needs to validate, where conflicts seem arise.
With constant development in the medical knowledge, from time to
time there can be some situations where validation falls into a
grey area - a policyholder will argue that their specific
illness is insured whereas the insurer will argue that it isn't.
Insurance companies are aware of this problem and they often
change the wording in their policies in an attempt to clarify
the scope of the cover and eliminate areas for dispute.
Nevertheless, disputes do happen all too frequently and sparks
fly when a policyholder thinks his illness is covered but the
insurer disagrees.
A case in point comes before the Courts shortly. Mr Hawkins from
Staffordshire is suing Scottish Provident for