Below are some case studies where we’ve declined a claim for different reasons.
Condition not covered
Case study one
A 50-year-old male green keeper took out a mortgage reducing life and critical illness policy for £95,000 in June 2008. In May 2011 he suffered a deep vein thrombosis (DVT).
A DVT is a blood clot that forms in the deep veins of the lower leg. If the clot travels, it has the potential to lodge in the heart or lungs resulting in sudden death. Although this is alarming, a clot is usually identified and dispersed before this occurs and anticoagulant medication such as Warfarin prescribed to prevent further clots. DVT is not usually life changing.
Deep vein thrombosis is not one of the defined Critical Illnesses covered on the policy so the claim was declined.
Case study two
A 48-year-old unemployed female lecturer took out £284,000, mortgage reducing life and critical illness cover with her husband in June 2007. In April 2011 she contacted us to say she had suffered a cardiac arrest.
A cardiac arrest is the cessation of the heart beat and can have a number of causes. It isn’t necessarily a heart attack.
As cardiac arrest is not one of the defined Critical Illnesses covered on the policy the claim was declined.
Definition not met
Case study one
A 46-year-old male sports coach took out a joint mortgage reducing life with critical illness policy with his partner in October 2009. He had presented to hospital in July 2011 with a two day history of severe chest pain.
The cardiologist confirmed he had suffered from a heart attack. However, the blood enzyme test results confirmed that the heart attack was below the severity threshold required. His claim for £56,467 was declined in November 2011.
Case study two
A 37-year-old insurance consultant took out £50,000 reviewable life including critical illness protection in June 2004. Slight traces of blood were first detected in her urine in 2009 and it recurred in February 2011. It was initially thought to be an infection, but when things didn’t resolve further tests revealed a ‘non-invasive’ transitional cell bladder carcinoma. This was removed.
‘Non-invasive’ cancers are specifically excluded from the cancer definition as they have a very favourable prognosis.
Next steps
If you would like more information you should talk to a financial adviser.
Are you a policyholder?
Call us on:
08456 00 14 02
If you have a question about a specific product or service visit our contact pages.