Critical Illness Cover - Potential Exclusions

It is a bit strange writing this guide as I am writing about a potential downside to a product that offers vital protection to those who take it out. But. It only seems fair that when we assess the products that we offer our clients that we are completely transparent and also point out the times when things are not perfect.

Critical Illness Cover provides financial protection should you be diagnosed with a medical condition listed within your policy set of claimable conditions, during the term of the policy. With many insurance providers this will mean that you will receive a lump sum payment upon the official diagnosis of a condition from approximately 40 illnesses.

Critical Illness Cover comes with a 14 day survival period for any claim to be considered valid. This means that should you be diagnosed with a severe heart attack one day and unfortunately die 13 days later, the insurer will not accept your claim. However all is not lost. In order to overcome this, Critical Illness Cover is almost always combined with Life Insurance and any worthwhile adviser should discuss this with you thoroughly. This is because for a minimal (if any) price change you are then guaranteed that if you should die within the 14 day survival period, your claim will automatically be transferred to the Life Insurance aspect of the policy.

Where things can get a bit trickier again is in regards to exclusions on the policies. Exclusions are placed upon Critical Illness Insurance primarily when there is a significant medical history of the applicant, or the applicants family. This is not always the case and it is very much analysed on a case by case basis by the insurer you approach. What you need to do though is ensure that you approach the right provider for you. Some insurers are more flexible with applicants who have had depression in the past whereas another may be more accommodating to those with a close family history of multiple sclerosis.

We have taken the most common exclusions that we have come across and listed them for you below, with examples of the type of applicant circumstances that cause the exclusion. Please be assured that exclusions on Critical Illness Insurance are not the norm and if your individual circumstance is listed in the table below, this does not automatically mean you will have exclusions on your policy.

* Depression would only usually be excluded from the TPD element of a policy if included.

It should also be noted that any self-inflicted injury that causes a critical illness from your claimable set will not result in a successful claim with most companies; for many conditions it would simply not be possible to cause the illness on yourself.

There are a number of different exclusions that can be placed on a Critical Illness Insurance policy, but the ones discussed above are the most common. Whilst saying that, it is really important that you understand that these exclusions are not made here there and everywhere. Insurers will not place exclusions on policies unless there is genuinely a higher risk of the applicant placing a claim due to their medical history or occupational hazards.

We regularly speak with customers who have any number of the ‘potential causes’ for exclusion that are detailed in the table and are able to source Critical Illness Cover for them with our insurers. We know which insurance provider to approach with your specific circumstances so that we can secure the best terms for you. You may receive normal/standard rates for your policy, you may have an exclusion placed on the policy. But the thing that I always like to remember is that even if one condition is excluded from the policy claims set, there are still be at least 39 other conditions that you are insured for.

If you would like to speak with one of our qualified advisers about any thing discussed here feel free to call us on 01723 518140.