Premium
Customisable watchlists with full streaming quotes from leading exchanges, such as LSE, NASDAQ, NYSE, AMEX, Bovespa, BIT and more.
Over the past year Resolute Claims have seen a marked increase in the amount of Terminal Illness claims rejected or ‘deferred’.
Terminal Illness is normally a ‘free’ benefit attached to a Life or Critical Illness policy. It is designed to pay-out the full sum insured should a policy holder become ‘terminally’ ill. This normally means the expected prognosis is less than 12 months (It is worth noting most insurance companies will not pay this benefit within the last 18-24 months of the policy). It is designed to help people in the last months of their lives financially, repaying a mortgage, going on a family holiday or such.
When someone applies for this benefit the insurance company will write to their consultant and possibly GP. They will most likely ask the consultant about a predicted prognosis. Most medical professionals will be cautious about providing a definite prognosis as their aim is to ensure that people live as long as possible. They might give a percentage answer (90% of people will die within 12 months etc) other might say 6-18 months with treatment and 2-6 without treatment.
If you are thinking of applying for this benefit, it is important to speak with your consultant first. Tell them about the requirements of the policy and that the insurance company, this will give them a little more context around the report once they receive it. Some people experience a rejected terminal illness claim because the information provided by the consultant is ambiguous. For example, where the life expectancy may be 12-24 months with treatment, but treatment may be unsuitable for the person meaning they have a considerably shorter prognosis. You should always let the consultant know it is their opinion and it will not ever come back to them for any reason (if someone lives longer than their prognosis).
We have seen several cases where the insurance companies Chief Medical Officer (CMO) has disagreed with the prognosis given by people’s own consultants. They will often quote medical literature or new treatment that may be available to extend your life. It is important to note that the persons consultant has the best understanding of the illness and likely progression and opinions of the insurance companies CMO can be very successfully challenged. To appeal a rejected insurance decision we often need to gain further information from your health care professionals.
We have also seen some questionable behaviour from insurance companies in ‘deferring claims’ until the latest round of treatment has finished. We had a client who came to us after having their claim ‘deferred’ for 3 months after being given a 6-month prognosis. The insurance company advised this was to see how the treatment progressed. After the 3 months had passed, they were in the last 24 months of their insurance so the insurance company advised they could not accept the claim.
Over the past month Resolute Claims have taken several insurance companies to the Financial Ombudsman and successfully appealed declined terminal illness claims. This has resulted in the insurance company paying thousands of pounds in compensation on top of the insured amount. If you need free guidance or help you can call us on 0333 050 8792.
