Has anyone had any experience with critical illness insurance being refused? I have paid for a policy for 15 years and after my open heart surgery made my claim, only for Legal and General to say I didn’t have the ‘right kind of heart surgery’.
I want to appeal or maybe even get legal advice, but if anyone has any tips/advice/recommendations I’m all ears!
I suspect it may be because looking back on your posts you had a congenital heart defect, i.e. were born with it. Have you read the small print in deysir?
We had an issue with my husband's critical illness cover because stupidly we didn't realise that we were supposed to notify the company of a change in income. My husband barely worked for quite a while before his operation and although the company paid out - they only paid out on what his income was prior to his operation. We had been paying in for a larger amount. Lesson learned the hard way. Your contents insurance may have free legal cover if you want to challenge this.
Had no problem getting a payout but this was following a NStemi which was a listed event for payout, check your policy for wording. Nearly didn't claim as I never thought about it during my recovery.
Hello. I had a similar experience with Aviva. When I was diagnosed with Arteriosclerosis requiring surgery they tried to argue that because I'd been on statins for years that I must have had a pre-existing condition..I mentioned this to my consultant who promptly wrote a 'To whom it may concern ' letter dismissing their argument. I had a double bypass at the end of June this year paid for by Aviva.I suggest you explain the situation to your cardiologist and see whether they might do something similar if appropriate. Good luck
Legal and General are notorious for this even with cancers unfortunately. See if your doctors can help with pursuing your claim or seek advice from Citizens advice bureau. Persevere if you can.
while in hospital, my wife was told if I didn’t have a mid line incision ( cut my chest bones open) for a bypass & aortic valve replacement they wouldn’t pay any insurance at all.
Whoever reads small print like that?
Thanks for everyone’s ideas, we have gone back to look through all the small print and spoken to a doctor about it and have some ideas to move forward before I seek legal advice. After speaking with friends it’s amazing how many people are stuck in similar old policies, and although it doesn’t help me they’ve all gone looking for newer ones that cover more!
Critical illness insurance can be refused for several reasons, and understanding why an insurer might decline your application can help you improve your chances of approval in the future. Here are some common reasons for refusal:
1. Pre-existing Medical Conditions
If you have a history of serious medical conditions such as heart disease, cancer, or diabetes, insurers may view you as high risk and either deny your application or charge significantly higher premiums.
2. Age
Many critical illness insurance policies have age limits. If you're applying outside the covered age range (often 18–65), your application may be denied.
3. Lifestyle Factors
Unhealthy lifestyle choices like smoking, excessive alcohol consumption, or drug use can increase your risk of critical illness, leading to a refusal. Some insurers may offer coverage but at higher premiums if they see a risk due to lifestyle choices.
4. High-Risk Occupation or Hobbies
Jobs that involve significant risk, such as working in hazardous environments, or hobbies like skydiving, scuba diving, or motor racing, can lead to a denial of coverage.
5. Incomplete or Inaccurate Application
Failure to provide accurate or complete information during the application process, including omissions about your medical history, can lead to refusal. Insurers require full transparency to assess your risk accurately.
6. Medical Test Results
Many insurers require a medical examination or access to medical records. If your test results show indicators of potential health issues, the insurer may refuse coverage or limit it.
7. Family Medical History
A family history of critical illnesses, especially if close relatives have been diagnosed with diseases like cancer, stroke, or heart disease, can increase your risk profile and result in a refusal.
8. Financial Reasons
Some policies may have coverage limits based on your income or financial situation. If you apply for coverage that’s disproportionate to your financial standing, the insurer might deny your application.
What Can You Do If Refused?
If your application is refused, you can:
Appeal the decision: If you believe the refusal was unjustified or based on incorrect information, you can contact the insurer and provide additional documents or clarify your situation.
Shop around: Different insurers assess risk differently, so you might have better luck with another provider.
Seek specialized insurers: Some insurers specialize in high-risk individuals or those with pre-existing conditions, though the premiums might be higher.
Make lifestyle changes: Improving your health (e.g., quitting smoking, losing weight) can increase your chances of approval in the future.
Would you like advice on how to approach an appeal or alternatives if you've been refused?
Thankyou for your advice but I think you misunderstood. I have held my insurance for 15 years. They won’t payout after I claimed on it. I have now had to take legal advice.
Travel insurance
Aviva Critical illness , anyone claimed following heart attack & CABG ?
Travel insurance
Travel Insurance Dilemma...
Holiday Insurance
