Insurance World

If you’re in the unfortunate position of having to make a claim on your critical illness insurance policy, the last thing you want is insensitive hassle or apparent non co-operation from your insurer. But according to numerous newspaper articles, that’s precisely what’s happening. The core problem is that before they’ll pay out, the insurer will always want to make exhaustive enquiries about your past health record. Whilst you’ll have provided them with lots of similar information when you initially applied for the cover, the insurers will now insist that all the information is rechecked. And if at the time you said you weren’t a smoker, they’ll now want this verified by your doctor.

The reasons are obvious. They’re faced with a big claim, typically way over Ј100,00, and they want to be certain that you told them the entire truth about your health when you first applied. This means that now you’ve claimed, they’ll crawl over your medical records in great detail checking that you disclosed everything on your application. Every small and apparently insignificant detail will be subject to intense scrutiny. The problem is that their reams of correspondence can be quite upsetting for you.

The insurers defend their procedures saying that they need to be certain that when they accepted the business, you disclosed the full truth about the factors affecting your health. They want to be sure that you didn’t cheat by omitting some information in order to dupe the company into issuing a policy when they otherwise might not, or to help you qualify for a lower premium. Either way, non-disclosure as they call it, is cheating and a valid reason for them refusing your claim. It doesn’t even matter if the information you omitted ultimately had nothing to do with the illness that occasioned the claim. The insurers position is that every piece of information you provide was used to work out your premium and any omission affects the calculation.

The insurers are particularly distrustful if the claim arrives within the policy’s first five years. Any claim arising during this period is classed as an “early claim” and the insurers are particularly watchful for policyholders who took out the critical illness insurance already suspecting that that they were already ill.

The problem is that all this intense scrutiny attracts a very bad press. If you’re very sick and distressed, the last thing you want is lots’ of questions and high-handed hassle from your insurer.

There’s undoubtedly a conflict here. If they are to neutralise the bad press, the insurance companies need to work much harder at softening the enquiry process and they must liase much more closely with their claimants. Insurers must present a much softer centre at what is a most distressing time for their claimants.

All this adverse PR has had two effects on the critical illness insurance market. Applicants have apparently been favouring insurers who publish the lowest rejection rates and others have withdrawn from making any application.

In practice, avoiding insurers who publish high refusal rates has little benefit. That’s because the published figures can be misleading. The latest figures show that Scottish Equitable Protect has refused to pay out on 28% of critical illness claims followed closely by Friends Provident at 25%. If you compare these figures with Scottish Provident at 13.7%, many potential policyholders can be forgiven for favouring Scottish Provident. But that’s not necessarily the best decision.

The problem with interpreting these figures is that the figures themselves can be distorted by how long the insurer has been active in the critical illness market. As rejection rates are highest with policies that have only run for a few years, then companies that are new to the critical illness market will automatically have the highest rejection rates. This leaves companies such as Guardian Financial Services looking good with a rejection rate of just 10%. The truth is that the Guardian has been in the market for over 15 years and has a mature book of business.

And it’s a pity that all this negative publicity has undermined confidence in critical illness insurance. In our view, this insurance plays an important part in protecting family finances but people are being deterred from buying it, leaving their family unit exposed if they become seriously ill. After all, if the main income provider is taken seriously ill, the family’s income can plummet. That means that the tax-free lump sum paid out by these policies can become central to the family’s financial survival.

Our advice is if you think you need critical illness cover press on. But be aware that these policies vary a lot in the cover they offer - so straight price comparisons aren’t really meaningful. Basic plans will cover one or more of the most serious conditions but comprehensive plans cover many more – for example:

Alzheimer’s disease
Aorta graft surgery
Aplastic anaemia
Bacterial Meningitis
Benign brain tumour
Blindness
Cancer
Cardiomyopathy
Chronic lung disease
Coma
Coronary artery by-pass surgery
Creutzfeldt-Jakob disease
Deafness
Dementia
Heart attack
Heart valve replacement or repair
HIV or AIDs from an assault, blood transfusion, occupational duties or accident
Keyhole heart surgery
Kidney failure
Loss of independent existence
Loss of limbs
Loss of speech
Major organ transplant
Motor Neurone disease
Multiple Sclerosis
Paralysis/Paraplegia
Parkinson’s disease
Progressive Supranulcear Palsy
Stroke
Third degree burns
Total and Permanent Disability
Cover for children

This complexity means that you really need independent advice. There are plenty of web sites that can help you. Just search for “critical illness insurance” and make sure you can talk to an adviser before you buy.

Disputes, especially when it comes to settling insurance claims, are not new scenarios. In fact, they take place every day. Just what causes these disputes? Well, one of the obvious reasons is most policy holders think that they deserve to be paid a larger settlement than what they receive. Second, claims are slow to process. And third, claims are denied.

There are various ways to deal with your auto insurance company. First, is the aggressive approach, which I am not encouraging since I am a peace-loving individual, and believe that everything should be settled in a peaceful and civilized manner. There are actually several peaceful options which a policyholder may undertake depending on the degree of insurance dispute.

For cases wherein your insurance agent is unable to solve your problem, it is advised to get the name and then the phone number of your insurance company’s claims department. Afterwards, call the consumer complaint department and never hesitate to tell them your problem because they may be able to help you. And don’t forget to get the name of the person whom you talked with in the consumer complaint department.

The next step is to send all documents to the consumer complaint department to back up your complaints. Send it to the person whom you talked with in the consumer complaint department. But be sure not to send the original copies of your documents. Have your documents photocopied because you need the original copies in case you have to take the matter to court.

Another option that you have is to ask for reassessment of your claims from the appraisal service or the arbitration service of your insurance company. If the result still has not satisfied you there is always your own state’s insurance department that may be able to help you.

However, if you still feel that you have not been given a satisfying solution to your insurance problem you may call 1-800-942-4242 which is a toll free consumer information service that is sponsored by the insurance industry. They have trained personnel that are available to assist and answer queries relating to various auto insurance complaints. They are available Monday to Friday, from 8:00 am to 8:00 pm.

Nevertheless, if you still feel that after you have applied all the above-mentioned options and yet you feel that you have not been given the appropriate solution you want, you can always take the matter to court. You can hire a lawyer, preferably one who is an expert in handling auto insurance cases.

There are many qualified lawyers out there who may be able to help you. According to studies, insurance claims have a much better chance of being settled if it is done with the assistance of an auto insurance expert lawyer. This is because your auto insurance lawyer knows every miniscule detail there is to know regarding auto insurance claims. Protect your rights; hire an auto insurance lawyer to help you.