Insurance World

Recent stories in the press have again lambasted the insurers over critical illness insurance. The core problem is that a critical illness claim is not as straightforward as, for example, a claim under life insurance. With life insurance it’s going to be hard for the insurance company to argue that you’re not dead!

By their very nature, critical illness claims are much more complicated. The insurer will need to satisfy itself that the claim is validated in three key areas before it meets the claim: -

Has the illness been correctly diagnosed?

Is the confirmed illness included in the schedule of insured critical illnesses covered by the policy?

Did the policyholder fully disclose their medical history and current state of health on their original application form?

On the first point, it’s obviously in the policyholder’s interest to verify the medical diagnosis - so there’s rarely ever any conflict between the insurance company and the policyholder on that issue. It’s the next two areas which the insurer needs to validate, where conflicts seem arise.

With constant development in the medical knowledge, from time to time there can be some situations where validation falls into a grey area – a policyholder will argue that their specific illness is insured whereas the insurer will argue that it isn’t. Insurance companies are aware of this problem and they often change the wording in their policies in an attempt to clarify the scope of the cover and eliminate areas for dispute. Nevertheless, disputes do happen all too frequently and sparks fly when a policyholder thinks his illness is covered but the insurer disagrees.

A case in point comes before the Courts shortly. Mr Hawkins from Staffordshire is suing Scottish Provident for Ј400,000 under the terms of his critical illness policy. Basically, his medical advisers believe his illness is insured whereas the insurers’ medical advisers disagree. If the Court find in favour of Mr Hawkins the press will have a field day - and the critical illness insurers will suffer further bad press they can sorely afford.

Another summons, filed recently in the High Court and again involving Scottish Provident, highlights the problem when an insurer considers that a claimant mislead them on his or her original application form. Our understanding is that if an applicant omits relevant information or provides misleading information on their application from, this amounts to obtaining insurance on false pretences. This summons has been issued on behalf of Thomas Welch from London who is suing Scottish Provident for Ј206,800. The issue goes back to 2000 when, a few years after first starting his critical illness policy, Mr Welch received confirmation that he was suffering from testicular cancer. The insurer refused the claim because of “non-disclosure alleging that Mr Welch had not been honest about his smoking habit. He does admit that he did smoke earlier in his life but is resolute in saying that he had long since given up when he applied for critical illness insurance. As such, Mr Welch believes that he did complete the application honestly.

We assume that the case will centre upon whether Mr Welch accurately answered the smoking questions on his application. Most insurers define “a smoker” as someone who has smoked, or has otherwise used, nicotine products within the previous 5 years. (Some insurance companies adopt a 1year cut off.) If Mr Welch had indeed smoked during the specified years, he would have been obliged to disclose such information on the application and the insurer would have priced his insurance accordingly. In this context, it is relevant to note that smokers are charged as much as 65% more for critical illness over than non-smokers. We anticipate that Mr Welch’s lawyers will argue either that he did not smoke during the period in question or he omitted the smoking information by pure oversight and in any event, his past smoking is not irrelevant to his testicular cancer. Interesting issues and we’ll let you know the outcome.

Mr Hawkins case is fundamentally different. It illustrates the problems that can arise if policy documents imprecisely describe an illness or if the technical diagnosis of an illness provides the scope for medical professionals to disagree. Either way the issues are entirely outside the policyholders control at a distressing time for them and their families and we must appreciate their anguish. The long-term solution must lie in improving the medical definitions within the policy. It is probable that this will result in more medical jargon that the average man in the street will find difficult to understand - but perhaps that is preferable to what Mr Hawkins is going through.

Mr Welch’s court case must stand as a clear reminder to everybody that applications for insurance must always be totally accurate and completed in good faith. We recognise that in some cases this may still leave room for dispute (and Mr Welch’s case may be an example), but if an applicant fails to complete the forms accurately, they are taking the great risk and any claim they make could be rejected.

Rightly or wrongly, the newspapers have a history of giving the insurance companies a hard time, casting them as heartless big business. This serves to reinforce the public’s feeling that insurance companies are devious and not to be trusted - especially it seems, in respect of critical illness insurance. This view is reinforced by the fact that around 20-25% of critical illness claims are rejected (although this rejection rate does vary between insurers). This issue is something that insurers must come to grips with – it’s bad for clients and undermines confidence in insurance - and that must be bad for the development of the insurance industry.

In fact to put no finer point on it, it’s a tragedy. As many as 1 in 6 women and 1 in 5 men will be diagnosed with a critical illness before their normal retirement age*. As such, critical illness insurance is vastly important for the protection of family finances. The problems we have highlighted are obviously contributing to a situation where almost everybody needs critical illness insurance, but fewer and fewer of us are taking it up.

(* Source: Munich Re.)

Is it coming round to the time to renew your car insurance? Do you, like 23% of car owners, just accept the quote and stay with your insurer? Does it matter that the premium is 5 or 10 per cent more expensive than last years? Maybe it’s just not worth the hassle of all those phone calls to goodness knows where, thumbing through the yellow pages or wearing out your shoe-leather down town. In addition to this, Insurance companies offer the best rates to new customers, in order to gain their custom. Existing clients generally stay with them anyway.

What about the internet? It really is worth giving it a try. Do you know that, if you shop around you could, on average, save around Ј55, plus the extra online discount? It is estimated that more than 2.25 million car owners purchase their car insurance on line now. The internet is speedy and simple to use and internet sales are generally growing amazingly fast.

Car insurers really want your business; they will be extremely competitive with pricing in order to win you over. There are around 100 of them in the UK and due to the strong competition in the industry; prices have held level for the past year or so. You can go to the individual insurers websites, comparison websites or use one that recommends specific insurers for different types of driver, whether they be the in the young, higher risk category or the experienced old driver with years of proven safe driving behind them. You will receive instant results and an unbelievable amount of advice and information. You’ll be asked to fill in your relevant details, for example the number of years you’ve been driving, whether there are any convictions, number of years of “no claims” for your discount. All easily answered and your no claims details should be on your renewal notice.

Apart from the straightforward individual car insurance, new categories of insurance are coming on to the market. There are pay as you go options and multi-car policies. These used to be difficult to obtain unless you were in the car-trade. It certainly seems to be time to re-assess what’s available in the car insurance line and get yourself up to date on what’s on offer. A short time browsing the internet will get you thinking along the right lines.

A word of warning though; The AA’s Ian Crowder says “If we don’t start to see modest price increases, then there could well be an unpleasant and sudden price hike. This will not be good for the industry’s reputation or out customers.” Insurers are beginning to show signs that they may not be able to continue to hold down prices for very much longer. Claims are accelerating. The average cost of accidental damage repair has risen, costing an additional 5% per year, despite the fact that there are fewer accidents. Claims for personal injury are rising fast and the cost of settling these is rising at around 12% per annum.

Don’t give your insurer the chance to use this as an excuse for a rising premium, get on line and get sorted!