Each insurance provider will have their own terms and conditions. Platinum Financial Consulting deal with all the leading providers in the UK. If you ask us to place insurance on your behalf, we will make sure we use the provider whose terms and conditions best meet your needs.
The information we provide below is therefore not necessarily the terms and conditions that you will be offered. They are simply a generic outline of the conditions offered by most providers, and are given here as a guide to better aid your understanding.
What is the aim of a critical illness policy ?
When can I make a claim ?
What conditions are normally covered ?
How do they assess Permanent Total Disability ?
Own or Any Occupation, What does it mean ?
Are there any other Benefits ?
Are there any instances when the policy would not pay out ?
More detailed information on selected conditions
What is the aim of a critical illness policy ?
These policies exist to help you when you have an illness that is going to have a major impact upon your life.
However some conditions are not covered, even though being diagnosed with the condition may be traumatic. The most obvious examples are some forms of cancer.
Fortunately, due to medical advances, some cancers are now treatable and therefore these cancers will be excluded on most providers' policies. It is important to stress that the more serious cancers are still included.
Whilst there may be a few variations between providers on the conditions covered, most reputable insurers create their lists in line with those illnesses considered critical by the medical profession and The Association of British Insurers.
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When can I make a clam ?
If you are diagnosed with a critical illness, then a claim should be made.
Some insurers will pay out immediately, others may require you to survive for a period after the onset of the first symptoms. This is typically for a period of 30 days.
Many insurers will also include terminal illness benefit in the policy. This will pay the sum assured if you are diagnosed with a terminal illness with a life expectancy of less than 12 months (irrespective of whether it is on the critical illness list or not).
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What conditions are normally covered ?
Please remember that this is a typical list of conditions covered, but it is not definitive. If you are keen to make sure a specified condition is covered, then please make us aware. Also just because a disease is not on our list does not mean that cover cannot be obtained. For example, some insurers cover Creutzfeldt-Jacob Disease (CJD commonly known as Mad Cow disease) - we have not included it in our list below because many insurers do not cover it.
Where we feel necessary, we have included further definition on some conditions at the foot of this page. You can also click the info link in the list below.
Alzheimer’s Disease
Aorta Graft Surgery
Aplastic Anaemia [info]
Bacterial Meningitis
Benign Brain Tumour
Blindness
Cancer (normally malignant types only) [info]
Cardiomyopathy
Chronic Lung Disease
Coma
Coronary Artery By-Pass Surgery
Deafness
Dementia
End Stage Kidney Failure
End Stage Liver Failure
Heart Attack [info]
Heart Valve Replacement or Repair
HIV/AIDS (some exclusions) [info]
HIV/AIDS Blood Transfusion [info]
Loss of Limbs
Loss of Speech
Major Organ Transplant [info]
Motor Neurone Disease
Multiple Sclerosis
Paralysis
Parkinson’s Disease
Progressive Supranuclear Palsy
Stroke [info]
Third Degree Burns
Total and Permanent Disability
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How do they assess Permanent Total Disability ?
Your policy will include a series of activities or functions that determine whether you are classed as disabled. Normally if you are unable to perform three of these functions without assistance you will be classed as disabled and the policy will pay out.
Please also see the Own or Any Occupation section
These tests are know as “functions of daily living” - however insurers will test them differently.
As a comparison, one insurer uses the following "functions of daily living":
Walking; Bending; Communicating; Reading; Writing and Climbing.
In this instance, Climbing means “having the ability to climb a flight of 12 stairs without stopping or suffering severe discomfort”.
Another insurer uses the following:
Walking; Standing; Use of a Pen, Pencil or Keyboard; Hearing; Speech and Vision.
It is important when you first take out the policy that you are happy with the tests for disability.
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Own or Any Occupation, What does it mean ?
Some policies require you to state if the policy is to be on an Own or Any Occupation basis.
This Own or Any criteria puts an additional layer of assessment into determining Permanent Total Disability.
Disability benefit may or may not be payable depending if you selected a policy that had an “Own” or “Any” occupation definition.
If your policy has an Own Occupation definition, then it will pay out if, in the opinion of the insurer, you are unable to continue your own occupation and this will continue to be permanent.
A policy that has an Any Occupation definition will only pay out if, in the opinion of the insurer, the person insured is unable to pursue any occupation and will be permanently unable to do so.
To use an example, it may be that a taxi driver is no longer able to drive following an accident, but despite their disability they could be employed in a different job.
If the policy was set up on an Own Occupation definition, then the policy will pay out, but it would not pay out if it was on an Any Occupation definition.
Nevertheless, even if the policy was on an Any Occupation definition, if the policy holder fails the "functions of daily living" tests mentioned in the previous section, the policy should still pay out.
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Are there any other Benefits ?
If you buy a critical illness policy for yourself, many insurers will also cover your children to a limited level.
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Are there any instances when the policy would not pay out ?
You run the risk of the policy not paying out if:
You don’t maintain the premiums
You were found to be untruthful, either at the time of application or claim
Your condition is not covered in the policy
Most insurers will not pay a claim from a cause that arises whilst you are living abroad for more than 12 months.
Most policies contain a clause that says it will not pay if your claim results from: drug abuse or self-harm, HIV/AIDS (unless named groups, blood transfusion or assault), war and civil commotion.
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More detailed information on selected conditions
Please remember that this is only a guide. You will need to check the specific conditions offered by your insurer.
Aplastic Anaemia
Permanent bone marrow failure which results in anaemia, neutropenia and Thrombocytopenia, and which requires treatment by either :
Blood transfusion
Marrow stimulating agents
Immunosuppressive agents
Bone marrow transplant
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Cancer
Most malignant tumours characterised by the uncontrolled growth and spread of malignant cells.
Cancer also includes leukaemia and Hodgkin’s disease.
Exceptions tend to be :
All tumours that are pre-malignant / non invasive
All tumours of the prostate unless certain criteria are met
Any skin cancer other than invasive malignant melanoma
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Heart Attack
The death of a portion of the heart muscle due to inadequate blood supply.
A series of test are normally applied to confirm the degree of severity.
Angina may not be covered on many policies.
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HIV/AIDS
This is a complicated area and this section is an attempt to simplify matters for reasonable understanding.
People who work in certain recognised professions, such as health and emergency professionals, who have contracted HIV/AIDS as a result of their professional duties would normally be covered.
There are very strict rules and time limits imposed when making a claim.
If HIV/AIDS is contracted from a blood transfusion, then most insurers would cover this.
You may also be covered if infection results directly from some kind of physical assault. Again, strict rules around making a claim apply. It also has to be evident that you in no way encouraged or provoked the assault.
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Major Organ Transplant
This typically covers the transplant of :
Heart
Liver
Lung
Pancreas
Bone marrow
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Stroke
A cerebrovascular incident resulting in permanent neurological damage.
Transient Ischaemic Attacks tend to be excluded.
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