The experience in markets where critical illness covers had been sold may not have been pleasant. Results may have showed rough policy definitions, non disclosure by critical illness policyholders and moderate claims handling by insurers. This might have led to several problems. To avoid such dilemmas, a standard set of regulations may have been used to achieve a critical illness product of quality. Let’s have a look.
The critical illness definitions used can be put in such a way that questions arising about what is covered may be less. In other words, critical illness definitions explained in the policy may be clearly understandable once read. Furthermore, the critical illness policy may also specify how and when the insured person should make the company aware about a claim. Basically, the claimant may be required to present the critical illness claim in written to the company. This may be done within three months after the critical illness had struck. After this, the claimant may be also required to produce full details of the critical illness. In most of the cases, a claim form may be available so that the critical illness claim may be assessed easily and the payout made quickly.
Moreover, the critical illness policy documentation may include that before payment is done some aspects of the claim might be reviewed. For example, the company may have the right to ask for any proof related to the critical illness claim made as well as the claimant’s health at the start of the policy. Additionally, the insurer may also be able to request the claimant to undergo specific medical tests by any doctor of the company’s choice. Here, cases of non disclosure might appear which could lead to the critical illness claim being rejected. Non disclosure has been and may still be a cause of concern in the critical illness industry.
In addition to, knowing about the complexity of the critical illness conditions covered, the company might lay down some rules. Thus, in the occurrence of a critical illness claim, full clinical, radiological, histological and laboratory evidence might be recommended. They may be as follows:
Cancer
In case of a claim, it may be essential to have a copy of the histological report so that the critical illness is confirmed to be met by all the definitions set by the policy. Details about the tumour may also be required as stipulated by the International TNM Classification of Tumours.
Heart attack (myocardial infarction)
In this case, for facilitating the critical illness claim assessment, past and new ECG reports, hospital reports and laboratory evidence may be essential. Should the complete report submitted reveal that all the circumstances mentioned above are not covered, the critical illness claim might then be declined.
Stroke
Here also, medical reports may be required to confirm the presence of the critical illness at the date of claim. The report might also demand proof of the disease lasting for 24 hours and also the existence of the critical illness even after three months.
Coronary artery bypass surgery
The need for surgery for this critical illness might demand proof of a coronary angiography. A copy of the angiography report accompanied by the surgery report may be enough for the critical illness claim to be accepted.
Kidney failure
To confirm a critical illness like kidney failure, medical as well as laboratory evidence may be supplied. These evidence may include, (e.g. creatinine, creatinine clearance, urinalysis) and a confirmation that regular dialysis (hemodialysis or peritoneal dialysis) is carried out.
So, looking at this data, it might therefore be essential that you read your policy well to ensure a worthwhile cover under critical illness insurance.
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