Some claims facts

The top critical illnesses based on claim volume are:
Cancer
Heart attack
Stroke
Multiple sclerosis
Benign brain tumour
The average age of a claimant averages 45 (for males) and 43 (for females).

Receiving the news from your doctor is difficult for your family and you but your critical illness cover can provide a sturdy wall you can lean on. In particular, when you are aware that you are able to file claims and receive reimbursement to help you with the costs you require for your treatment.

Based on reports on claims submitted by major insurance companies, the percentage of claims paid ranges from 91 percent up to 98 percent. A key element to a successful claim for critical illness is to file the claim in a proper manner.

Here are a few basic dos and don’ts to consider when submitting a claim:
Do:

Give full disclosure. While it’s not too late to do this, it is important to keep in mind that you must to disclose your current health status at the time you submit the application. If you don’t, it could result in your critical illness claim rejected.
What details do I have to provide when making a critical illness claim?

Here are the documents that you must provide to send:
Completed claims form.
Your doctor’s medical report. Typically, your physician should be working within an “approved” country and be an expert in the disease being treated.
Diagnostic and laboratory reports.
Contact information and personal details.

Get documentation. It is recommended that you keep all medical records. You’ll have to submit them when you submit an application.

For help claiming on critical illness insurance get in touch with our team.

Contact your insurance company at once. As soon as you are diagnosed with a health issue that is covered under your policy, you need to inform your insurance company about it. So, you can begin to get the claim process can begin. This will ensure that you are able to claim earlier and that you know what documents you’ll need to submit your claim.

In order to ensure that your claim is timely and successful, filing, be aware of the deadlines in your policy.

Be prepared to make an appeal if your claim is denied. In case your claim gets denied, you may appeal. Having your claim denied at the very first attempt is not the end of the road for you. You can work with the insurance claims adjuster to determine the additional details needed in order to strengthen your claim.

Don’t:

Most commonly, claims are denied due to not meeting the policy definitions:

Heart attack. Certain heart problems can be mistakenly labeled as a heart attack when it is not.
Stroke. Transient ischaemic attacks can appear similar to symptoms associated with a stroke but recovery typically occurs after 24hrs. They are not covered under the policy.
Coronary angioplasty. Claims can be denied for coronary angioplasty when the narrowing is less than 70 percent in more than two arteries.
Bladder cancer of the bladder. If it is diagnosed early, the disease can be treated, and it is non-invasive.

It is assumed that you are protected. It is important to know exactly what coverage your policy provides. There are a variety of definitions of an illness covered Therefore, you should find out under which conditions the illness is payable. Be aware that the insurance company will only cover your claim falls within the definition of policy. If not the claim, it could be denied because it didn’t meet the required criteria.

For instance, there are some cancers that are not covered – some cancers that aren’t critical and may be treated generally not covered under the critical illness policy. There are also certain conditions covering your date of birth, the country in which you received your diagnosis, and other specifics.

Complete the application form If you’re not sure of the details. If there’s a medical detail in the form that you’re not sure about, ask your doctor first before writing everything down. Be sure not to leave any gaps – the insurer may not contact your doctor to check areas on your application form.

You haven’t paid your premiums. In this instance, it could be early in the game however your failure to pay your premiums by the grace period could be a sign that your insurance policy is no longer in force. Also, you need to continue with the premium payments while your claim is handled.

Make any fraudulent claims. One of the reasons is that an insurance firm will thoroughly verify the validity the claim. If they discover you’ve made a false claim, they will deny your claim. Additionally, they could “blacklist” your name and it could affect subsequent applications you make to insurance firms. You may also face charges because of your fraudulent claim.

What are the main reasons some serious diseases don’t get any coverage?

The illness that is being claimed is not covered under the policy.
The illness does not meet the criteria set forth in the policy.
The illness is excluded. Know more about the excluded conditions by reading the Exclusions to your Critical Illness policy
The applicant gave insufficient or inaccurate medical data which could have led to that application denied or refused cover.

Can you make an appeal if you believe your claim was denied?

If your claim is denied, you can still lodge an appeal, first, to your insurer , and then to an agency of the government. If you feel that your claim is a valid one, then you could appeal to your insurance provider. It is important to provide the reasons in the form of your appeal. If you have any additional evidence in support of your claim, this is the time to present it to the court for review.

If, following an appeal however, your claim is denied, you can submit a letter of complaint to the Financial Ombudsman Service.

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