Life and Critical Illness Insurance | Life and Critical Illness Insurance Information

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The Financial Services Authority has recently carried out a review of the way in which information and advice is given to retail customers purchasing financial products. One of the products which they considered was the sale of Critical Illness Cover.
Critical Illness Cover is often taken out by people taking out a mortgage, usually as part of a term assurance policy. It may also be purchased as a stand-alone product. The policy will pay out a lump sum if the borrower becomes seriously ill with one of a list of specified illnesses, commonly cancer, heart conditions, stroke etc.; this will help with loss of earnings due to the illness and general life-style changes which may be the result of the illness.
Firms selling critical illness cover are required to comply with certain standards and although these are being met reasonably well, the survey showed that there could be some improvement in the way in which they could help the customer to gain a better understanding of the product.
The FSA have visited firms and employed mystery shoppers to look specifically at how compliancy is working out with regards to sales processes when selling critical illness cover.
Supervision visits were paid to 42 firms. Whilst in the main these were financial and mortgage advisers, they also included banks, building societies and insurers. The market research company, Research International, carried out 80 mystery shops to 51 firms in total, to report on what actually occurs.
Director of Retail Firms, Sarah Wilson, has said that whilst many of the findings were positive, a few problems had been identified. Initiatives have been launched in order to deal with them. The fair treatment of customers is of prime importance, especially with regard to making policy application forms and documents more easily understood. So far these changes seem to be helpful.
Critical illness cover is, however, complex and some of the problems cropped up in the context of the financial promotion of the schemes and general insurance documentation. Customers sometimes have difficulty in comprehending exactly what they are being sold. Therefore it is difficult for them to assess whether this is the correct cover for them, or whether a payment of income protection product would be more suitable.
The needs of the customer have to be taken into account and there should be a careful assessment of the type of protection which they need. However, where there were two or more types of policy, the cost was sometimes the only aspect taken into account when recommending the most suitable one. Other factors may have been left out of the equation, such as conditions covered or whether there were other products more suited to a particular client’s requirements.
Miss-selling is a risk, but most firms had taken reasonable measures to manage this. There were found to be good training programmes and risk based monitoring.
As is the case with prime mortgage payment products, customers have time to consider their options before they make the decision to purchase the cover.
The results of the survey offer some reassurance that the needs of the customer are being protected and any changes to be implemented can only offer change for the better.

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There’s a new critical illness policy on the market which attempts to go some way with regard to sorting out the perplexity regarding exactly what is, and is not, covered when it comes to claiming on the policy.

Traditional critical illness policies tend to cover up to 35 listed medical conditions. Policyholders could become seriously ill with a condition that doesn’t fall into the scope of the policy and find that their illness is not covered, whilst others may be diagnosed with a listed illness with a lower “grading” which is relatively easily treated, for which they get a full payout.
Because of this inequality, the Financial Services Authority is uneasy with regard to insurers failing to fully understand that cover is restricted to certain specific illnesses.

This new product is marketed by the Prudential, under the name of the Flexible Protection Plan, and is unusual in that it claims to cover an amazing 140 medical conditions. However, cover is based on the severity of the condition which could possibly cause some uncertainty regarding the grading of these illnesses.

This is how the plan works:

Listed in the policy are practically all serious illnesses and the payout when one these is diagnosed will be graded according to the severity of the condition. The Prudential says that by tying payments to the degree of seriousness of the illness means that more payments can be offered to people with debilitating illnesses, who may otherwise get nothing at all. An example of this is that should you lose the sight of one eye; the Prudential policy will pay 25% of the sum assured. Normally, critical illness policies would only pay out when total blindness occurs. In all, 140 severe conditions are covered.

A spokesman for one of the specialist financial advisers welcomed the range of the policy, but voiced some concern regarding the implementation of these severity-based payments, saying that it would be open to argument as to what level of severity some illnesses would be graded as. It was felt that it would not be advisable to enter into this type of policy unless you had a very clear understanding of exactly how it would work. We quote “It will be up to the consumer to decide whether a guarantee of getting a smaller payment is better than possibly getting nothing.”

The cost of this new policy is approximately twice as much as conventional critical illness cover.

If your main concern regarding insurance cover should you become critically ill would be the financial outcome, it might be better to consider life insurance. Particularly, if you have a family to support, you may need something that is going to guarantee their lifestyle in the worst case scenario and with the addition of some income protection cover, which would meet outgoings in the event of you becoming unable to work due to illness. This type of cover, unlike the critical illness policy, protects you against common conditions, which result in you being unable to carry out your work.

The best course of action would be to contact a broker and check out the alternatives. The internet’s a good place to start and there are some good internet discount’s available, along with plenty of advice. A good broker will be able to compare the products available and come up with the right insurance product for you.

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You have taken out a critical illness insurance policy so that if you ever are in the unfortunate situation of developing a life threatening condition, you will be compensated.
But what if you wind up with a critical illness that is not guarded against on the insurance policy? What many people do not realise, and what can be of real concern, is that you may find that after you have purchased critical illness insurance you are only covered for up to 35 listed medical conditions. And this is the deal with most insurance policies. So if you develop a life threatening illness not named in your policy you could be faced with the disastrous situation where you get no pay out from your insurance company at all.
On the other hand, it could be that you have an easily treatable sickness and because it is ranked with what the insurance industry calls a “lower grading”, you end up getting a full payout.
The Financial Services Authority and the Association of British Insurers are wary about whether insurance companies actually make these differences clear.
Jonathan French, a spokesman at the Association of British Insurers, says it is important that customers have an insurance policy fully explained to them before it gets purchased. “The situation we would not want to see occurring is for them to be buying a product thinking that it does something it doesn’t do.”
And for this reason, the ABI recently updated its codes of best practice for critical illness insurance. French says until recently, 35 conditions was the maximum number any company covered for critical illness insurance.
“What we set out are essentially the minimum standards companies have to apply to their policy. The guidance we have published improves the way the critical illnesses are defined. It makes it clear to consumers what levels of illness are covered and what aren’t.”
The cost of critical insurance varies. For someone in their late 30s for a 35-year term with a payout of £500,000, premiums cost anything up to £600. Scottish Equitable charges premiums of £290 and Scottish Provident charges £409 premiums for policies based on these conditions. Both these policies are reviewable. A guaranteed policy with Scottish Provident is £560.
So these figures give you an idea that the amount of money you pay out for this type of insurance can be expensive. You can imagine how infuriating it could be to find that you have paid out on the policy only to learn that when you do become critically ill your insurer will not pay you out.
There is now, however, a new critical illness product on the market. Prudential is marketing a new ‘Flexible Protection Plan’, which covers up to 140 medical conditions.
In the ‘Flexible Protection Plan’ there are partial payouts depending on the severity of the condition. If the condition worsens, there is more paid out to the maximum sum which has been insured. Most other policies do not offer partial payouts.
Take loss of eye-sight for an example. It would normally be the case with a critical illness policy that you would only receive a pay out if you became completely blind. But the Prudential policy will pay out 25% if you loose sight in just one eye.
But here is the catch. The cost of the policy is almost twice that of conventional illness cover and spectators worry that there will be some confusion about how the severity of an illness would be defined.

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You can buy pretty much everything over the Internet these days and this most certainly applies to insurance. But the process of buying something over the telephone or Internet means that you do not have the benefit of having a person in front of you to explain something in depth if you do not understand.

Another thing is that as a growing number of people begin to start buying products online, there are new problems that occur – teething problems shall we say that keep cropping up as more companies start offering services over the Internet for the first time.

With complex insurance policies like Critical Illness Insurance, a type of insurance where sometimes people do not fully understand exactly what they are buying, it is an area that could become a problem.

The Association of British Insurers thinks so anyway, which is why the organisation is improving the standards of the insurance application process via the telephone or the Internet for different types of health and protection policies, including those for critical illnesses.

A spokesman for the ABI, says: “Because the mechanics are slightly different when you are applying for a policy on the internet, you need to look at that process slightly separately and that is what we are doing at the moment. It is a piece of work that is on-going and it will improve the application process for telephone and Internet applications.”

The ABI’s spokesperson explain that it is not exactly that there have been problems with people buying medical policies like Critical Illness Insurance over the internet before, but the new standards will simply just recognise that buying a financial product over the internet means that financial companies have to change the way they collection personal information.

“It is more a recognition that we need to translate the new good practise that we have put in place on paper to the online and telephone application process. The methods of collecting the information are subtley different,” the ABI said.

The move to improve standards for buying health insurance policies for things like critical illness on line comes after the ABI this year launched various measures to make the steps to buying health policies simpler for both consumers and financial advisers. The organisation also updated guidance specifically for Critical Illness Insurance, offering guidelines on how to bring more clarity to application forms. The entire overhaul of personal medical insurance guidelines meant improvements to the leaflets offering advice on Critical Illness Insurance, the removal of ‘memory test’ questions like ‘have you been to a doctor in the last five years?’and clear warnings on application forms about the consequences if you do not reveal pre-existing medical conditions. The changes came after speaking with cancer charities and other organisations. It was hoped that the guidance would reduce the likelihood that a claim would be declined for non-disclosure of a pre-existing medical condition.

The ABI’s spokesperson said, “Having put in place what we believe to be higher standards of clarity on the application form, we clearly want to apply those higher standards to all forms of underwriting application.”

The work being carried out by the Association for online applications is still work in progress. And it is still unclear when the new standards will be released. But regardless of the time frame, it is certain that they will definitely be released soon.

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You can buy pretty much everything over the Internet these days and this most certainly applies to insurance. But the process of buying something over the telephone or Internet means that you do not have the benefit of having a person in front of you to explain something in depth if you do not understand.
Another thing is that as a growing number of people begin to start buying products online, there are new problems that occur – teething problems shall we say that keep cropping up as more companies start offering services over the Internet for the first time.
With complex insurance policies like Critical Illness Insurance, a type of insurance where sometimes people do not fully understand exactly what they are buying, it is an area that could become a problem.
The Association of British Insurers thinks so anyway, which is why the organisation is improving the standards of the insurance application process via the telephone or the Internet for different types of health and protection policies, including those for critical illnesses.
A spokesman for the ABI, says: “Because the mechanics are slightly different when you are applying for a policy on the internet, you need to look at that process slightly separately and that is what we are doing at the moment. It is a piece of work that is on-going and it will improve the application process for telephone and Internet applications.”
The ABI’s spokesperson explain that it is not exactly that there have been problems with people buying medical policies like Critical Illness Insurance over the internet before, but the new standards will simply just recognise that buying a financial product over the internet means that financial companies have to change the way they collection personal information.
“It is more a recognition that we need to translate the new good practise that we have put in place on paper to the online and telephone application process. The methods of collecting the information are subtley different,” the ABI said.
The move to improve standards for buying health insurance policies for things like critical illness on line comes after the ABI this year launched various measures to make the steps to buying health policies simpler for both consumers and financial advisers. The organisation also updated guidance specifically for Critical Illness Insurance, offering guidelines on how to bring more clarity to application forms. The entire overhaul of personal medical insurance guidelines meant improvements to the leaflets offering advice on Critical Illness Insurance, the removal of ‘memory test’ questions like ‘have you been to a doctor in the last five years?’and clear warnings on application forms about the consequences if you do not reveal pre-existing medical conditions. The changes came after speaking with cancer charities and other organisations. It was hoped that the guidance would reduce the likelihood that a claim would be declined for non-disclosure of a pre-existing medical condition.
The ABI’s spokesperson said, “Having put in place what we believe to be higher standards of clarity on the application form, we clearly want to apply those higher standards to all forms of underwriting application.”
The work being carried out by the Association for online applications is still work in progress. And it is still unclear when the new standards will be released. But regardless of the time frame, it is certain that they will definitely be released soon.

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Critical illness cover (CIC) is a type of insurance which
provides a significant one-off payment if you are diagnosed with
a specified life-threatening condition – specified being the
important term, because if your illness isn’t in the terms and
conditions – you won’t get the payment. Over recent years,
critical illness cover has gained in popularity due to lower
costs and apparent simplicity.

Critical illness insurance can be sold as part of a mortgage
package or additionally as a stand-alone policy. Critical
illness cover can also be commonly associated with life
insurance, with certain CIC policies paying out either on the
diagnosis of a particular illness or on death, but not both,
whilst other CIC policies pay out in both events.

When you first purchase the critical illness insurance policy,
there might be an option for buy-back insurance, this would
permit you to buy additional critical illness cover or life
insurance, typically at a minimal cost, after you have made a
claim on your existing CIC policy. It is often worth considering
such an option, as the survival rates from a critical illness
are usually very good and it can be extremely difficult to
obtain new cover following a critical illness. Buy-back critical
illness cover usually protects against the three major critical
illnesses: heart attack, stroke and cancer from which you are
most likely to recover, but also risk an attack later in life.

Bear in mind that when you take out life critical illness
insurance, there is a standard waiting period between diagnosis
and possible payout, from six months to a year for certain
conditions, such as total permanent disability. However, if the
diagnosis is very transparent, it is possible that the insurer
would consider waiving the waiting period. The maximum payout
varies from policy to policy thought it’s not unusual to see
capped payouts of £500,000 or £1 million, though cover for
higher amounts might be available on request. When the policy is
sold as part of a mortgage package, the lump sum is designed to
pay off the loan on the home, but with other policies, there may
be no restrictions on how you use the money. Suggested uses may
encompass covering living expenses whilst you are off work,
though the money could additionally pay for private medical
treatment, carer services, home improvements, career retraining,
help for your dependents and even a holiday or break away.

Nearly all critical illness insurance policies cover seven main
conditions: cancer, heart attack, stroke, kidney failure,
coronary artery bypass, multiple sclerosis and major organ
transplant. Policy exclusions in critical illness insurance may
include Alzheimer’s or Parkinson’s disease if diagnosed after
the age of 60. Don’t be seduced by long lists of ailments – as
other policies may include these but under a broader heading. It
is important to note prior to taking out a policy that there may
be certain exclusions in the insurance contract which may
prevent payout due to life choices and circumstances. According
to the Association of British Insurers, the most common
exclusions include:

* Aviation * Criminal acts * Drug abuse * Failure to follow
medical advice * Hazardous sports and pastimes * HIV/AIDS *
Living abroad * Self-inflicted injury * War and civil commotion

The consumer organisation Which? estimates that two thirds of
the population suffer from a critical illness at some point in
their lives. However, whilst the principle of critical illness
insurance might be relevant, it is always worth ensuring your
policy meets your exact needs, so if the worst happens, you’re
not caught out by the small print. It’s important to shop around
for quotes and different policies. Comparison sites such as
moneynet and moneysupermarket will allow you to do this.

Resources:

Critical illness insurance guide
from Channel 4

Critical illness insurance price comparison research

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GREAT NEWS! There’s now a one in five chance of you winning the lottery before you retire. Getting excited? Think it’s just a matter of time before you win? Think again, it’s not going to happen – but it got you thinking!Now think of the same odds but this time about bad news. There is a 1 in 5 chance for men and a 1 in 6 chance for women that a long-term critical illness will prevent them from working. Sorry – this time it’s true.Insurance cannot change those odds but it can alleviate the potential financial wreckage caused by being unable to work through long-term illness and still having a family and home to support. Convention declares that every good family man should have life insurance. It’s easily understood, it’s accepted and your next door neighbour has it too. But what about it’s close cousin critical illness insurance? You’ll have to walk several streets to find someone who has it. Given the odds, why? After all it pays out a tax-free lump sum immediately an insured critical illness is diagnosed. The usual reason given is its expense. Yes it is more expensive than life insurance but after all it’s providing cover for a greater risk. You’re much more likely to experience a critical illness than die before your normal retirement age. Indeed, the average age for a claim is 47. So clearly there is much more to the public’s resistance. Not understanding the risks or “head in the sand syndrome” are certainly major factors. After all a lzheimer’s disease, bacterial meningitis, brain tumours and leukaemia plus the long list of other illnesses typically covered by critical illness insurance, are not matters we care to think of nor know much about.

Could there be another reason? Well there have been repeated newspaper articles about people who claim on their critical illness policy only to have it turned down on an apparent technicality – the inference being that the insurance company cannot be trusted. Indeed, Standard Life freely admits that it turns down around 20 % of critical illness claims.

The truth is that behind every story of rejection there’s a harrowing story of illness, distress and sorrow – and potential copy for the journalist. But that in itself, is not evidence that the insurance company is guilty of devious behaviour.

Yes insurance companies do make mistakes, but more often than not the claim was invalid from the outset. There are two main causes. Firstly, the policyholder is claiming for an illness that is not one of the critical illnesses scheduled in the policy documentation. Regrettable, but it’s a fact that if the illness is not listed it isn’t insured and the policy won’t pay out.

The moral is to closely compare the illnesses covered by competing insurance companies and buy the one with the most extensive coverage of illnesses. If you don’t, sods law will prevail…

The second major reason for refusal is a failure to disclose all relevant matters on the original application form. For example, if the applicant fails to disclose in response to the insurance company’s questions that his father a died of a heart attack aged 50 or that he is having medical tests for headaches, then the insurance company will wrongly assess the risks it is being invited to insure. Had the insurance company known this extra information they might have increased the premium, or asked the applicant to go for a medical examination, or waited for the outcome of tests, or even refused to provide cover. By failing to disclose, the applicant has effectively obtained cover on false pretences or at least on inaccurate information.

Thereby lies the second moral. Always provide the truth and the full truth on your application form. Anything remotely relevant to your medical condition must be disclosed.

All this points to the need for professional insurance advice. Critical Illness policies do vary and it can take an experienced eye to evaluate the best policy for your circumstances and pocket. This doesn’t mean that you have to miss out on the discounted premiums available online – but do thoroughly talk it through with one of their telephone based advisers and do make sure you read the schedule of claimable illnesses when it arrives in the post. Then sit back knowing you’ve taken another important step to protect your family’s finances. Lets all hope that you’re one of the majority who are happy never to claim.

It’s now time to concentrate on enjoying life.

Michael Challiner has 15 years experience in financial services marketing at senior level. Michael now works as the editor of Express Life Insurance Futher reading What is Critical Illness Insurance.Futher reading Critical Illness Information Resource

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Twenty per cent of critical illness claims are turned down. That means for every five people making this important claim, one will have it rejected at this crucially important time.

The whole reason behind taking out critical illness cover is that, in the event of you becoming critically ill (that is being diagnosed with one of the listed illnesses described in your policy documents) a payment will be made. The reasoning behind your decision to take out what some consider being an important part of your financial planning is sound. Critical illness can affect the whole family. You may have to pay out for child care, change your home or job or even train for a completely new career. Having taken out cover, should the unexpected happen, all eventualities are covered and you have gone as far as you can to minimise financial problems and get down to the important personal matters.

Unfortunately, in a number of cases, this is not so. Failure to disclose what may seem to you to be minor, unimportant illnesses in the past may give the insurers a reason to reject your claim. Fair or not, it’s completely legal! As far as the law stands, if you have failed to disclose information which the insurer was seeking, then the insurer is perfectly within their rights to terminate the cover.

If this happens to you, not only do you have to cope with the implications of the illness, but you have to either accept that your critical illness insurance plans have totally failed you. At this stage depending on the severity of the illness, you may feel overwhelmed by the situation and unable to face challenging the decision. If you do appeal against the decision and the Financial Ombudsman Service gets involved, they will make every attempt to establish whether you deliberately misled the insurers in order to gain cover or whether the questions on the original proposal form were vaguely or poorly written.

As soon as you make a claim on your critical illness policy, your insurer will instigate an extremely thorough check on your medical records. It appears that they can go back without a time limit and if they find anything, related to your illness or not, which you’ve failed to disclose to them, they may choose to refuse your claim. There is no such search or investigation carried out when you take out the policy and some people feel that this should be addressed.

It is virtually impossible to remember every minor illness. Can you really be expected to remember and record every visit to the doctor regarding things like headaches, eye pain, stiff neck, ear infections and depression? There were recent cases where claims were rejected for these reasons – a man had his claim for prostate cancer refused because of failure to disclose an earlier ear infection and a woman whose claim failed because she’d not disclosed an earlier problem with depression.

However, for four out of five people, the insurance works. It is important to disclose your full health history and not to attempt to cover anything up. Read the terms of the insurance thoroughly and miss nothing out. Used as intended, critical care cover is a valuable financial tool.

Plenty of help is available when choosing your critical illness cover. Log on to the internet and you’ll find on-line brokers who’ll be able to offer advice, a choice of quotes and the best possible terms.

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Ladies, if your mother or any other female blood-line relatives have a history of breast or ovarian cancer then from next year onwards, you could face higher insurance premiums. You could even be refused cover altogether.
When these women apply for life and critical illness cover, the insurance industry wants to ask them whether they have been tested for the gene mutations BRCA1 or BRCA2. These are the gene complications that increase the chances of them developing these cancers. But before the insurance companies can ask these questions on their application forms, they must get approval from the Genetics and Insurance Committee, the body that advises the Government on these and similar issues.
In the coming months the Association of British Insurers (ABI) will be requesting the Committee for authority to ask women whether they have been tested positive for BRCA1 or BRCA2 gene mutations. These are the mutations that are present in 1 in 10 of newly diagnosed cases of ovarian cancer and 1 in 20 of new cases of breast cancer. Approximately 1 in 850 women in Britain inherit a faulty BRCA1 gene and of those, 14 – 18% will develop breast cancer during in their lives.
On the web site for the Genetics and Insurance Committee we found a notice saying, ” The Committee expects that the Association of British Insurers will submit in late 2006/2007 four revised and updated applications for the use of adverse results from the predictive genetic tests of the BRCA1 and BRCA2 genes (breast/ovarian cancer) in helping to determine insurance premiums for life and critical illness insurance”.
So far, application forms issued by British insurance companies are only allowed to ask for the results of predictive tests for Huntington’s disease. Even then, the question can only be asked when the application is for more than £500,000 of life insurance cover or mote than £300,000 for critical illness insurance or over £30,000 for payment protection insurance. This rule is set under an agreement entered into by the insurance industry which is due to expire in 2011 but the Chairman of the ABI’s Genetics Working Party, Harpal Karlcut, is reported in the trade insurance magazine “Cover”, as saying: –
“We are looking to get approval for the breast cancer test by the end of the year”, adding, “The two breast cancers are the next conditions that we will look at but after that we don’t see the need to look at other conditions. We do keep an eye out for what diseases may come up in the future but there is nothing else on the horizon”. We add another important rider – yet!

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Back in 1999, the Imperial Cancer Research Fund stated that one in every three people in Britain will be diagnosed with cancer at some point in their life. With rapid medical advances the chances of survival from a major illness are improving but the consequences of suffering such an illness continue to be substantial and life-changing.
Critical illness insurance policies are designed to help you cope with the changes which will be necessary should you be diagnosed with a “qualifying medical condition”. Most policies will pay out following a diagnosis of heart disease, cancer, stroke, renal failure, paralysis, major organ transplant and coronary artery bypass surgery as well as a range of other conditions. There is normally a one-off tax free payment which is intended to assist you with costs, typically the need to adapt your home or car or maybe re-train for a different occupation. It’s not only the bread-winner that can benefit from this type of cover and you should take account of child care and housekeeping costs which would be involved should Mum be out of action.
Unfortunately, at a time when most people are suffering from the shock of learning that they have been diagnosed with a critical illness, they and their families may learn some additional disturbing news. The insurance industries latest figures show that, on average, around a quarter of all claims are rejected!
As soon as a claim is made, the insurance company will request a huge amount of information from your doctor. It’s quite likely that much of this information is not relevant to the illness for which the claim relates. The insurer is using this information to ascertain whether or not the insured has been completely truthful on the original insurance application form.
The reason for this is what the insurers call non-disclosure and if any medical information has been omitted, they can use this as grounds for refusing the claim.
It appears that the non-disclosure may not be related to the critical illness. Claims have been turned down for various reasons, including the case of a woman with breast cancer whose case was rejected because she hadn’t listed treatment for depression on the original proposal form.
The rejection rates are shown as follows:
Company % of rejected claims
Scottish Equitable Project 28%
Norwich Union 26%
Friends Provident 25%
Legal and General 22%
Bupa 21.5%
Skandia 21%
Prudential 20%
Standard Life 20%
Scottish Widows 18%
Scottish Provident 11%
Scottish Equitable Guardian 10%
Average 23.5%
Despite the insurers claim that these rejections are perfectly legal, the Law Commission appears to think differently. There has been a consultation document published recently and the Commission makes the statement “It is possible for an applicant to act reasonably and honestly and yet still fail to meet the duty of disclosure.” The conclusions of these consultations will be reported on as soon as they are available.
It is therefore extremely important that when applying for this very valuable form of insurance, you disclose all previous illnesses. It’s probable that if you have to claim, then your medical records will be thoroughly examined and if the insurers consider you omitted medical information, they may “throw out” the request.
Compare companies for the best rates. Read the small print. Spend some considerable time in listing medical conditions. Relax – it may never happen.

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