Critical Illness Claims Report 2006

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1 This communication is intended for qualified financial advisers only and must not be relied upon by anyone else. This is the Critical Illness Claims Report 2006 from Assurance Limited

2 Hello. This report publishes the main facts around our Critical Illness plan claims from The report shows where this type of protection cover can have a huge positive impact for people who claim under this type of cover. Before your client buys a Critical Illness Protection Plan, we want you to be sure that both you and your client know what the plan is, how it works, and what the risks are. So what do Critical Illness plans do? Critical Illness plans pay out a lump sum if your client is diagnosed with a critical illness that meets our policy definitions during the term of the plan. The plan will end if we pay out a claim, except a claim for Children s Benefit. We only cover the critical illnesses we define in our policy and no others. These are listed at the end of this report. Page 2 of 7

3 Claims Statistics 18.7m total value of claims paid out 6 child benefit claims 92.5% of claims paid out 360 cases total number of claims paid 52,138 average claim value 500,000 largest claim value How do the claims break down Sex Male (47%) Age 0-39 years (33%) > 60 years (3%) Female (53%) years (64%) Page 3 of 7

4 Top five causes for claims during 2006 Other (14%) Benign brain tumour (3%) Stroke (4%) Multiple Sclerosis (8%) Cancer (60%) Heart attack (11%) We have a booklet which describes, in plain English, what we pay out. This is available from So when don t we pay? Our aim is to pay valid claims promptly and efficiently to help our customers in time of special need. We will assess claims in a fair and consistent way. There may be occasions when claims are not paid because of non-disclosure or where the claim does not meet policy definitions. What do you mean? Not meeting policy definitions Where we have not paid a claim because it did not meet policy definitions, it is because it did not meet one of the prescribed illnesses or conditions on the list contained at the end of this report. We will only cover the critical illnesses we define in our policy and no others. Nothing more, nothing less. Non-disclosure Where a claim has been declined because of non-disclosure, it is because a customer has not made a full disclosure of their medical history at the time of application for the cover. This could be because they failed to tell us about a particular hospital appointment, or medication they might be taking or have taken in the past. According to Cancer Research UK, every year more than a quarter of a million people are newly diagnosed with cancer. (Source Page 4 of 7

5 So how do I avoid my claim being rejected? It is vital that your client can, where possible, tell you or the insurer all they can reasonably remember about their medical history and that of their family during the application process. In the event of a claim, this reduces the risk of the claim being declined due to non-disclosure. 20% % 10% 10% 8% 5% 3.3% 4.2% 0% Declined because the claim did not meet policy definitions Declined due to non-disclosure We have seen a huge reduction in the number of claims declined in Multiple Sclerosis (MS) is the most common disabling neurological condition affecting young adults. Around 85,000 people in the UK have MS. (Source Page 5 of 7

6 What conditions are included in Critical Illness cover? The complete list of critical illness conditions we covered in 2006 is shown below: Alzheimer s Disease Aorta Graft Surgery Aplastic Anaemia Bacterial Meningitis Benign Brain Tumour Blindness Cancer Children s Benefit Coma Coronary Artery By-pass Surgery Creutzfeldt-Jakob Disease Deafness Dementia before age 65 Heart Attack Heart Valve Replacement HIV Infection for Emergency and Healthcare Services HIV Infection from Blood Transfusion HIV Infection from Physical Assault Kidney Failure Liver Failure Loss of limbs Loss of Speech Major Organ Transplant Motor Neurone Disease Multiple Sclerosis Paralysis / Paraplegia Parkinson s Disease Stroke Third Degree Burns Total Permanent Disability Before we can accept a claim, we must have satisfactory evidence that one of these conditions has been diagnosed or treated. The diagnosis or treatment of any conditions must be given by a consultant of a hospital in the UK whose specialism is appropriate to the cause of the claim, and the diagnosis must conform with our definitions. We have updated our definitions in line with the Association of British Insurers (ABI) guidelines, and with several conditions we have exceeded the ABI definition. These will be implemented in April The British Heart Foundation estimates that there are about 55,000 heart attacks per year in men aged under 75 living in the UK and 20,000 for women. (Source Claims Philosophy Customer Service Our aim is to pay valid claims promptly and efficiently to help our customers in time of special need Fairness We will assess claims in a fair and consistent way. To be fair to all policyholders, we will not pay invalid or fraudulent claims Confidentiality Claims will be handled in a secure and confidential environment Regulation and Compliance We will comply with all appropriate legislation, Association of British Insurers code of practice, and will be bound by the decisions of the Financial Ombudsman Page 6 of 7

7 Pensions Mortgages Savings Investments Healthcare Insurance Speak soon. For more information on the products in this booklet or if there is anything more about we can help you with, please call us on this number or go to the website below: Call charges may vary. Certain classes of product mentioned on this page are provided by other subsidiaries of. Assurance Limited, registered in Scotland (SC286833), House, 30 Lothian Road, Edinburgh EH1 2DH, authorised and regulated by the Financial Services Authority Calls may be recorded/monitored. CD Page 7of 7

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