Written by: Andy Walton - Proposition Director - Protection
Facing a critical illness diagnosis isn’t ever going to be easy, as it is likely going to be a life-changing event. Remember though, the reason you have critical illness cover is to take the stress out of the process by making sure you’re financially covered.
This guide will walk you through the process of making a critical illness claim so you can focus on what matters most - your health and well-being.
Understand your policy
You should get a sense of what your policy includes and how much your critical illness cover could pay out. You also want to be aware of what isn’t included. While you should already be aware of this, it won’t hurt to familiarise yourself again.
If you have any questions, or are unsure if you’re covered for something, get in touch with your provider. They will be able to help clarify anything confusing, and likely offer to start the critical illness claims process while you’re on the phone.
Start the critical illness claim process
Most providers will want to speak to you on the phone, as they can then provide more support in what is likely to be a difficult time. That being said, if you prefer, you will also have the option of filling in a full claim form. Your provider will work with you to provide a service that suits your needs.
Once you’re ready to start, you should make sure you have all your documents together.
Get your documents in order
The sooner you get all your paperwork sorted, the smoother the process will be. You will likely need to provide the following for a critical illness claim:
- The completed claim form
- Policy documents
- Proof of identity
In addition, your provider will likely reach out to your GP for information regarding:
- Medical reports
- Proof of diagnosis
If your insurer needs more information from you, they will let you know. It’s important to respond as promptly as possible to avoid delays.
How the assessment process works
Your insurer will carefully consider your claim and supporting documents. It can take about 2-4 weeks, but it can vary depending on the complexity of your case. They will make sure that your diagnosis doesn’t conflict with any of their policies, and they will also make sure that you offered full disclosure when you signed up.
They will have taken great care to do their research before you even signed a policy, such as speaking with your healthcare provider and investigating your medical history. Though unlikely, if they missed something in those early stages, and discover it during your critical illness claim, they will likely reject it.
Even if it seems unrelated, they need all the information in order to offer you informed policies. This doesn’t happen often, and providers are very diligent about ensuring transparency.
Most of the time, the only reason a claim will be rejected is if the insurer did not have all the facts. Even with that, the average claims acceptance rate for insurance is 98%1, so it’s unlikely to happen if you gave all the right information.
Understand the outcome
There will be three possible outcomes following a claim. You will either be approved, in which case you’ll receive the payout outlined in your policy. If your claim is denied, you have the right to appeal.
In this case, the insurer must provide details for why you were denied.
Finally, there may be a request for further evidence. This just means that the insurer needs more information to make a decision. Provide this as quickly and as accurately as possible.
Receive payment and move forward
Once your claim is approved, you should receive your payout shortly. You can use these funds to cover medical expenses, lost income, or any other financial needs arising from your illness.
After your claim, make sure you follow these extra tips:
- Keep copies of all your documents submitted
- Stay organised and keep communication with your insurer clear
- Get professional advice if you need help understanding your policy and what happens next.
Remember, you’re not alone in this. There are a wealth of resources and support organisations out there to help you through this challenging time. A few examples include:
-
Macmillan for cancer support
If you have made a claim and need to review your policy, get in touch with us today and let’s see if your insurance policy is still fit for purpose, or if you need to amend your critical illness cover.
References:
1. ABI, 2023
Important information
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