Does Critical Illness Insurance Cover Serious Illness?

Summary.
The requirement for precision and candour when writing critical illness insurance plans. This article explains.

Nothing is more harrowing in life than to be diagnosed with a serious or chronic condition. Matters are made much worse when your insurance company notify you that they won’t pay out on your critical illness policy or private medical policy for the HIV or cancer you are suffering from.

You are asked to read sub-clause four of paragraph 328 of the small print, which states that you are suffering from the the  wrong sort of cancer. Only tumours below the knee are covered and only the first five days of your treatment will be paid for, and then it is up to you to find the finance.

This situation may sound absurd, although brokers and insurance companies are regulated, this type of procedure continues to carry on. It has been a slow process to freshen up the industry and to make sure that consumers get a fair deal. That’s why you need mortgage insurance.

Just recently Cancer Backup, a registered charity, emphasizes this predicament by arranging a huge array of mystery shopping surveys, which brought to light some alarming facts about the private health insurance industry. It found that of all the leading insurers only HAS provided cover for cancer patients right through the length of their illness. Only immediate treatment is covered by most of the health insurance policies. Treatment or care over a prolonged period, such as hormone replacement or chemotherapy is not normally included.

Even though insurance companies and brokers want to finance long term cover for policyholders with chronic illnesses, they won’t always make it clear to would be clients, at the time of signing up what they are covered for. That’s why, when you are looking for quotes for mortgage cover, you need to be careful.

Although both  Cancer Backup and Macmillan Cancer support have been in discussions with similar organisations within the life insurance industry to raise the standard of sales practices and make the small print of policy documents much clearer, since the report was published two years ago, progress has been slow.

Critical illness cover and private medical insurance  is usually taken out by people who are comparatively fit and healthy. Getting cancer is the last thing to cross their mind. That is why it is imperative to specify an insurance policy’s exclusions before they sign.

A report of best practice for companies writing and selling medical insurance policies has been modified recently by the  ABI, which is a welcome step in the proper direction.

The trade body has now recommended that insurers and providers selling these forms of insurance should set up similar case studies, which explicates the conditions when a policy will or will not be paid. Sadly insurers no requirement to adhere to this code, which is voluntary.

While the  Association of British Insurers (ABI) initiative is to be appreciated, the best way of clarifying an insurance policy is by getting the salesperson to clearly explain the small print.

Then again, industry terminology is in spite of everything still being employed by insurers to bewilder the customer. For example it is wrong to categorize cancer as an acute or chronic illness, deliberates Cancer Backup. However insurance companies are definite that it should go in the chronic category. Consumers only learn about this when their claim has been rejected.

Although the ABI have got their responsibilities right, the insurance companies can only be required to better their standards by the regulator. Improved training of tele marketing staff, who sell the majority of the insurance policies, is also long overdue.

More thorough marketing procedures are crucial with jargon being removed. At the end of the day it falls upon the insurers insurance companies to make sure that their clients are fully aware of the terms of their insurance cover before they put pen to paper.

Posted by admin   @   16 November 2009

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