Last reply 2 years ago
Claiming critical illness cover

Hi All,

I met up with another person who has MS last night and she mentioned claiming if I have critical illness cover.

I’m curious to know whether I’m likely to get a pay out and how severe my symptoms need to be before they will pay out…

Has anyone on here been successful claiming? Did your condition need to be really bad before they would or should I get it when I’m first diagnosed for the amount I’m covered for.

I’ve started the claim now so will see what happens but thought I’d see if anyone on here can share their experience.

All the best,
Sarah xx

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stumbler
2 years ago

@sarah_louise_biggs , if your policy specifies that MS is one of the critical illnesses covered, then put in a claim.

There’s been a few posts on the forum regarding Critical Illness Cover. You can find them by using the Forum Search function, magnifying class towards the top left of the page, and search for “Critical Illness Cover”.


vixen
2 years ago

Hi there. I made a successful claim within 2 months of being diagnosed! Call your company and have a chat, they’re generally very helpful. They had to write to my doctor and the diagnosis is confirmed by the neuro. Neuros and GPS are quite used to handling these things. It should be quite straightforward. If they do pay, this will effectively cancel the policy or future claims against which is something to think about. Don’t forget also you will need to inform DVLA if you drive. Good luck! X


keels
2 years ago

Hi Sarah Louise,
I have just had critical life cover pay out.
It wasn’t an easy process and initially they said they wanted to reject my claim.
Make sure you read small print of your policy as not all insurance companies follow the same process.
On the forms it will ask you if you want to see what your dr and consultant as written about you before it goes back to them. Make sure you tick yes, as what my consultant wrote about me was completely wrong.
I photo copied what l had written on the critical life cover forms as my short term memory is awful now days and l would never accept a call from them unless it was convenient for me to talk and l had a note book.

I hope this helps. Good Luck.

Thanks everyone! Really appreciate you getting back to me. @stumbler @vixen @keels

I’m wondering how much I’ll be entitled to… will it be the whole amount I’m covered for or does it depend on severity of my MS. The thing that confuses me is I got enough cover to clear my mortgage but will I get all of it after diagnosis or will they just give me a bit of it?

Guess I’ll find out in due course. I’m just very impatient!! (>•<)


stumbler
2 years ago

@sarah_louise_biggs , they should pay out the full amount.

It’s like any other form of insurance, you cover for a specified event. If it was life insurance, they wouldn’t be seeing if you were a little bit dead! It should be all or nothing. And, my bet is that you get all. 😉


vixen
2 years ago

Hello again. One thing, if you do get it and think about clearing your mortgage, it might be an idea to talk to a financial advisor before making a decision. That’s because there may be ways longer term that having the cash avaialable might come in handy. Could be anything, like getting a car which better suits you, or even thinking about new treatments that might be a amiable privately before NHS takes them up. You know what they say, that if you win a lottery amount for example, that you should wait 6 months before making a decision to spend. I’m not comparing critical illness to a lottery win mind, but just a thought 🙂


perkyjo
2 years ago

Hi. I claimed for critical illness cover. It was really really simple, (although it will depend on your provider) mine stated in the terms and conditions that as long as I had a definite diagnosis ie MRI and lumbar puncture it was covered. I’d very recently been diagnosed and didn’t have any serious symptoms.
Just remember like others have mentioned you probably won’t be able to get cover again or it will be very expensive. I believe companies are now not including it as a critical illness but if yours does and you’ve paid into it, why not claim. Oh and yes you will get the whole amount you are covered for. I paid off some of the mortgage and put some in a high internet account for a “rainy day.”

Thanks again @stumbler & @vixen !

Really appreciate it. And definitely worth talking to a FA, very good advice.

@stumbler , that’s really good to know… And one potential silver lining to this disease that leaves you with so much uncertainty…

Thanks guys xxx


keels
2 years ago

Your welcome Sarah Louise.

They paid me the full amount out.

Good Luck, let me know how you get on xxx


vixen
2 years ago

A positive spin on this for all of us…..it wouldn’t surprise me at some point in the next decade or so, that if research and treatments continue to advance as they are currently doing, that MS might maybe become not critical enough to warrant cover. Just a thought for everyone…..x


keels
2 years ago

Your welcome Sarah Louise.

They paid me the full amount out.

Another silver lining is we get two for one theatre tickets too.

Good Luck, let me know how you get on xxx


lou64
2 years ago

Hi Sarah Louise

Yes, I claimed, and it paid out in full. One of MS’s ‘silver linings’ I always say. Not many of those…..!

Louise

Hi All,
I’ve finally been given a decision on my policy but they’re only saying I will only get 25% of it… This is quite surprising and doesn’t seem fair. How do they know at this stage what it will be like in the future and surely I should get all of it. Has anyone else had to challenge the decision and how did they go about it?
Thanks in advance,
Sarah


tracyd
2 years ago

@sarah_louise_biggs

My critical illness claim with Legal and General went through really easily. I invoked it as soon as I had a formal diagnosis and they requested confirmation from both my doctor and neurologist that I had been diagnosed and what tests had been done (MRI and Lumbar Puncture)

The policy paid out in full backdated to the diagnosis date and refunding payments made in the interim.

Thanks @tracyd. Mine is with Vitality and it’s taken 3+ months for a decision to be made. I’ve had the lumbar puncture and MRI scans which have confirmed the diagnosis. It’s really frustrating and disheartening for them to say I am only getting 25% of my policy. Doesn’t make sense to me right now.

I’ve just had more info that I’m only category D (25% claim) because I need to fail two of the functionality tests before I’ll be given more of the policy. Does anyone know if I can contest this. Right now my symptoms aren’t that bad but I have no idea what they will be like in the future.


stumbler
2 years ago

@sarah_louise_biggs , it seems that on the Vitality policy, they pay out on the
severity of your condition. They have seven severity levels, A – G, from 5% – 100%.

They must use their functionality tests to calculate the severity.

Basically, the way the policy seems to work is they pay out based on how much the condition affects you. If the condition worsens, they will consider a further pay out.

You may need to check your policy documentation to understand how they calculate this severity…………………..

Hope this helps to control the stressometer. 😉


wjgregg
2 years ago

I was self-employed for 27 years, before I had two relapses this year. The second put me in hospital for three weeks. My mobility was compromised, and I had cognitive problems which meant that I couldn’t return to work as a barrister. Thank heavens that I kept up my premiums. Many was the time that I almost stopped paying when times were hard. I took out the policy after paralysis in 1993 (which my consultant now thinks was my first relapse. In 1993 it was diagnosed as encephalitis) but I was fine for 20 years after that, with no relapse. I started to slow down about 7 years ago and went to see a (rubbish) consultant about a foot drop. He just said it was a hangover from the “encephalitis” and said there was nothing that could be done… Despite my wife’s plea, he refused to do an M.R.I. scan. I went on my way, but kept paying the premiums. It really helps to get a good consultant’s report. When I was in hospital last summer the consultant was a general neurologist, not a multiple sclerosis specialist. When I came out of hospital I was told that there would be a 30 week wait to see a consultant at Preston (ironically, it would have been the chap who I saw 7 years ago…). I couldn’t face that, so I found a superb multiple sclerosis consultant, and paid privately. He told me that my multiple sclerosis, although relapsing remitting, was rapidly advancing. I started on Tysabri within weeks and, touch wood, all is still going well after five infusions.

I abandoned the hospital general neurologist, and got my specialist to do a report for the insurance company. I am extremely happy to say that they paid out without a quibble. The money has allowed me to pay the mortgage, and put some aside for my daughter’s education. I would have been completely stuffed without it. It has led to a massive reduction in my personal stress, which can only be a good thing. Self-employment and multiple sclerosis, I now know, are not a good mix.

I don’t know how much money is at stake, but it is definitely worth biting the bullet and going private, for a consultation at least, with a proper multiple sclerosis specialist. It is a difficult field, and insurance companies have been known (hard to believe, I know) to obfuscate and try to avoid payouts. You need the best you can on your side because the insurance company will not roll over easily.

A quick Google search of your local hospital will tell you which doctors, if any, specialise in multiple sclerosis. If there are none in that hospital widen your search to include private hospitals. If you are anything like me, a “jack-of-all-trades neurologist simply won’t do. You didn’t chase to get this disease, and you have paid the premiums. You deserve your payout.

Good luck to you.

Best wishes,

Jon

Many thanks for the replies guys. I feel a bit hard done to but at the moment I don’t have particularly bad symptoms. Let’s hope they continue to stay as they are and I don’t need to make a further claim in the future. They’re so sneaky though and seems like other insurers don’t have the severity levels to determine what people get paid out. I’m going to stay positive and keep on going the way I am. I wouldn’t have even known I could make any claim if it hadn’t been for another lady with MS telling me about it. And I wouldn’t know about this website if it wasn’t for her either! Thanks for your comments and support, as ever xxx

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