How to make a Critical Illness cover claim

Being diagnosed with a serious illness is an emotional time. So, making sure you have Critical Illness cover in place means you don’t have to worry about your finances at this stressful moment in your life.

Insurers understand that having a heart attack or stroke, or being diagnosed with cancer or multiple sclerosis, is difficult. So, many providers have dedicated teams that can process your claim to ensure it goes through as quickly and smoothly as possible.

Read on to find out how to make a Critical Illness cover claim.

Speak to your doctor

The first step is to receive a diagnosis. This may because you’ve noticed something unusual and have been to see your GP, who has referred you to a hospital specialist.

Or, if you’ve experienced a heart attack or stroke, you may have been admitted to hospital as an emergency and now you’re making a recovery.

Whatever your situation, you need to have a firm diagnosis when you come to make a Critical Illness claim.

Speak to your insurer

Once you have received a formal diagnosis, you should then get in contact with your insurer.

Many of the larger insurers, including companies like Aviva, will allow you to make a Critical Illness cover claim online. If you prefer, many providers have a dedicated Critical Illness telephone claim line, where you can speak to an expert to explain your situation.

Some insurers may then need you to complete a claim form where you can provide more details about your illness, and provide your consent for the insurer to speak to your doctor or specialist.

When you get in touch with your insurer you will normally need to provide:

• Your policy number
• Details of the illness
• Contact details for your doctor, specialist or consultant.

If your doctor charges you for completing any forms as part of your Critical Illness claim, the insurer will normally reimburse this cost if you supply them with an invoice. 

The insurer will then assess your claim 

Once you have made your Critical Illness cover claim, the insurer will then get to work processing your claim.

Insurers are committed to paying claims as quickly as possible, as they understand that it’s likely to be an emotional time and that the financial support might be essential – particularly if you’re unable to work.

One thing you should remember is that it’s important you continue to pay your Critical Illness cover premiums while your insurer is assessing your claim. If you don’t, you could run the risk of the policy lapsing and then you won’t receive a claim (if successful).

When the insurer assesses your claim, they need to establish whether you meet the definition of the illness, as outlined in your policy document. For example, some policies only cover more serious types of cancer, and so if you have a less serious diagnosis then your condition might not satisfy the policy definition.

To assess your claim, it is likely that your provider will have to contact your GP, specialist, or consultant so they can provide more information about the specific nature of your diagnosis.

If the insurer has to take this step, they will normally let you know. While this step might mean it takes slightly longer to assess your claim, it ensures the provider makes the correct decision based on your specific condition.

Once the insurer finishes their assessment, they will get in touch with you to let you know their decision. There are normally three outcomes.

Your Critical Illness claim will be paid in full

If the insurer agrees to pay your claim in full, they will normally send you the payout within a few days. Some insurers will send you a cheque, while others will pay a claim electronically by BACS or by telegraphic transfer.

It’s useful to remember that, as of February 2022, any Critical Illness payout you receive is free of both UK Income Tax and Capital Gains Tax.

Once the insurer has paid your claim, your policy will end and will not provide any further cover. So, at that time, you should cancel your direct debit or standing order with your bank as you won’t need to pay any more premiums.

Your Critical Illness claim will be paid in part

When you take out your Critical Illness cover, the medical and personal information you provide forms the basis of your cover and the premium you pay.

If, during the claims assessment process, the insurer finds that you provided inaccurate or incomplete information, they could adjust your claim. For example, you may not have disclosed an existing illness that might have affected the price you paid for your cover. 

In a case like this, an insurer may recalculate the reduced amount of Critical Illness benefit the premiums you have paid would have bought, if they had been paid at the correct level.

You will then receive a payout within a few days. Again, this may be in the form of a cheque, or a BACS or telegraphic transfer payment.

Your Critical Illness claim will be declined

In some rare cases, an insurer may decline your Critical Illness claim after they have made their assessment. This will normally be for one of the following reasons:

• The illness you have been diagnosed with is not covered by your policy
• The illness you have been diagnosed with does not meet the definition stated in your policy document. For example, some less serious types of cancer are sometimes not covered under a standard Critical Illness policy
• Your claim is excluded from the policy. For example, your illness may have been excluded from your cover
• You provided incorrect or incomplete information when you applied for the policy which, had the insurer known, would have resulted in them declining your application for cover.

The insurer will explain to you the exact reason why they have declined your claim. In most cases your cover can continue as before, as long as you continue to pay the premiums.

If the insurer finds out information that would have materially affected their decision to offer your policy on those terms, they may end your policy and return to you any premiums you have paid.

It’s important to remember that insurers pay out for the vast majority of Critical Illness cover claims. Figures from the Association of British Insurers (ABI) show that 91.3% of all Critical Illness claims were paid in 2020.

This equates to a total of almost 17,000 claims, with a total payout of more than £1 billion. The average Critical Illness cover payout in 2020 was £67,011.

Find the right Critical Illness cover for you

Are you worried about how you’d pay your bills or mortgage if you were diagnosed with a serious illness?

Would your family be able to maintain their lifestyle if you had to take an extended period off work to recover from cancer or a heart attack?

If you’d like to ensure there’s a financial safety net in place if you were seriously ill, Critical Illness cover can provide this.

We work with dozens of the UK’s leading insurers and so we can help you to find the right cover at the right price. As we have close links with many insurers, we can also assist you if you have a pre-existing medical condition and you’re worried about whether you’ll be accepted for cover.

Get a Critical Illness cover quote online now, or speak to one of our experts for a chat.