Get the whole story about Critical Illness and how this could affect you

Transcription

1 Get the whole story about Critical Illness and how this could affect you Aviva s Critical Illness claims report 2009

2 Aviva s 2009 critical illness claims report For most of us, the importance of having critical illness cover in place does not become clear until we need to make a claim. Over 117m reasons why our Critical Illness mattered to our customers in 2009 This brochure provides details of Aviva s critical illness claims for It aims to give you an insight into the types and amounts of claims we pay out on...and more importantly why its vital to protect what s important to you. Our critical illness cover can give you peace of mind when you need it most Why choose Aviva? Learning that you have, or a loved one has, a critical illness can be an incredibly difficult time. Naturally you ll be worried about treatment and money. There are lots of reasons to choose Aviva to provide your critical illness cover: l We re the largest insurance services provider in the UK. In fact, worldwide, the Aviva group looks after more than 50 million customers. 2 l Brochure We re Titlecommitted to high standards of service and customer care and continually strive for improvement

3 Contents Critical Illness cover 4 Key statistics for Claims by age and gender 6 Claims by illness type 7 Children s critical illness 7 Most of us know someone who s been affected by... 8 The claims process 9 We want to pay your claims - not decline them 10 Critical illness claims examples 14 Why Aviva? 15 aviva.co.uk 3

4 Critical Illness cover Advances in medical science hold out the prospect of living longer and surviving illnesses. Critical illness cover has become popular as surviving claimants can use the money to help pay off a mortgage, to pay for treatment, make changes to the home, pay for living expenses or even take a holiday to help recover from the illness. We want you to understand our Critical Illness cover and for you to have the confidence that in the unfortunate event you do suffer one of the illnesses covered, you will be able to claim under your plan. When will a critical illness plan pay out? Critical illness cover pays out a lump sum if you are diagnosed with a critical illness that meets our policy definition and then survive at least 14 days. We only cover the critical illnesses we define in our policy and no others. What types of critical illness plans are there? There are a number of providers of critical illness plans and there will be similarities between products, but it s unlikely that there will be any offering identical cover. To help you compare these types of policies, the Association of British Insurers (ABI) has published industry standard definitions for the illnesses most commonly covered and excluded. You can find these in the ABI Statement of Best Practice for Critical Illness Cover at their website, 4 Aviva s Critical Illness claims report 2009

5 Key statistics for 2009 In 2009 we paid 91% of claims 1,499 cases paid totalling 117,981,920 Average per claim - 78, at a glance Total amount paid 117,981,920 Total number of claims paid 1,499 Total percentage of claims paid 91% Average payout 78,707 Average age of male claimants Average age of female claimants 44 years 5 months 42 years 5 months Average length of policy before claim 6 years 1 month Total number claims declined 136 Percentage of claims declined as the illness did not meet the critical illness definition 6% Percentage of claims declined due to discovery of material non-disclosure at the time plan was taken out. 2% We ve consistently paid amongst the highest percentages of claims made. We ve also reduced the number of claims not paid through non-disclosure from 12% in 2005 to just 2% in aviva.co.uk 5

6 Who is most likely to be affected by a critical illness and the most common conditions Illness Male Female Cancer 54% 79% Heart attack 20% 2% Multiple sclerosis 6% 9% Stroke 8% 5% Heart surgery 6% 1% Benign brain tumour 3% 3% Other 3% 1% Claims by age and gender Male Female Less than Total Age range of claimants for 2009 This shows that critical illnesses can affect any one of any age, it may surprise you that the age group is the group with the highest number of claims 6 Aviva s Critical Illness claims report 2009

7 Claims by illness type 67% Cancer 10% Heart Attack 8% Multiple Sclerosis 6% Stroke 3% Heart Surgery 3% Benign Brain Tumour 3% Other Child critical illness Caring for a critically ill child may mean that carers have to take time out from work and, in such times, the proceeds from a claim can help to alleviate the financial stresses. In 2009, we paid out on 51 children s critical illness claims. The diagram below shows the illnesses paid out on: Child claims 76% Cancer 10% Brain Tumour 10% Other 4% Stroke On all new plans, children s cover applies to children between the ages of 30 days and 18 years old on the date of diagnosis. The maximum we will pay for each child is currently 20,000 or 50% of the insured amount, whichever is lower. aviva.co.uk 7

8 Most of us know someone who s been affected by We d like to think it will never happen to us but hundreds of thousands of people fall critically ill every year. This often has a devastating impact on the people around them. Cancer There are around 293,600 new cases of cancer diagnosed each year in the UK and there are more than 200 types of cancer, with breast, lung, bowel and prostate cancers accounting for over half of all new cases. Heart More than 30,000 people have heart surgery in the United Kingdom each year. l 3,436 aortic valve replacement operations with a national survival rate of 98%. l In 2007, 19,957 heart bypass operations with national survival rate of 98.3%. The national survival rate for all types of heart operations is 96.6%. Source: Source: Care Quality Commission 2007 Stroke Every year, an estimated 150,000 people in the UK have a stroke. Most people affected are over 65, but anyone can have a stroke, including children and even babies. A stroke is the third most common cause of death in the UK. It is also the leading cause of severe disability. More than 250,000 people live with disabilities caused by stroke. Source: Multiple Sclerosis As many as 100,000 people in the UK are estimated to have multiple sclerosis (MS), a chronic neurological disorder. It is the most common condition of the central nervous system affecting people between the age of 20 and 30. The cause of MS is unproven, but evidence increasingly suggests that it is the result of an interplay between as yet unknown environmental factors (possibly viral agents) and genetic susceptibility. 8 Aviva s Critical Illness claims report 2009

9 The claims process Treating customers well is the rule not the exception Our dedicated Claims Team have had specific, bespoke training in the skills required to be able to give a helpful, empathetic, first class service and our claims process puts our customer at the heart of what we do. Step 1 Tell us you need to make a claim and how you d prefer to complete the claims form (by phone or post). You ll need to keep paying your premiums while we assess your claim. BY PHONE We ll arrange a suitable time to call you, and complete the claim form with you over the phone. Step 2 BY POST We ll send you a claim form to complete and post back to us. You can also call us if you need help completing this. Step 3 MEdICAL INFOrMATION We ll request the medical information we need to assess your claim typically reports from your GP and hospital consultants. Step 4 We ll assess all the information and make a decision on the claim. ACCEPTEd Once your claim has been accepted, we ll let you know by telephone right away. If we need anything else from you, we ll let you know. Step 5 NOT ACCEPTEd If we do not pay your claim, we ll tell you this and give our reasons for the decision. aviva.co.uk 9

10 We want to pay your claims not decline them Non disclosure Treating customers fairly is of paramount importance to Aviva and our aim is to pay all legitimate claims as quickly as possible. Critical illness claims are paid if you have a valid policy and the claim meets the policy criteria. A valid policy means that there has been full disclosure to the questions asked at the application stage, the policy is still in force at the time of claim, and the premiums are up-to-date. This reflects our commitment to paying out on all valid claims and to reducing the number of claims that are turned down. We only declined 2% of claims due to non disclosure, a massive reduction from our 2005 figure of 12%. This has been achieved through our work in raising awareness with advisers and customers to make sure all information is disclosed on the application form. It s important that you fully understand the cover provided by the product and you are sure that it meets your needs. Steps to avoid claims being declined: 1. Complete the application form truthfully, completely and in as much detail as possible. 2. Don t assume we will contact your doctor to fill in any gaps. 3. If you remember any additional information after you have submitted your application, do let your adviser or us know. 4. Read the definition you re covered for and ensure it matches the diagnosis. Call us if you are not sure. Insurers can only provide cover if they know the full facts about the person they are insuring. If you don t provide all the information that is asked for on the application it could mean that a claim you make may not be paid. If you are unsure whether you match the definition of your plan, please contact the Claims Team on , who will be happy to help you with your claim. Criteria not met We re finding the biggest problem is customers not understanding what they are covered for. In 2009, 8% of the claims we received were non-valid claims. Because of this, we would like to raise awareness of what we mean by criteria not met. A claim falls under criteria not met where it doesn t meet the definition set out in the insurance policy document. They can fall under two areas: l claiming where an illness doesn t meet the definition as described within the plan conditions l claiming for an illness or condition that isn t covered by the plan. We have included our criteria not met figures in our key statistics, but if criteria not met were not included this would show that out rate for claims paid out is 98%. 10 Aviva s Critical Illness claims report 2009

11 We would like to help customers understand what we mean by criteria not met and detail below some examples. Our Guide to Critical Illness offers an in-depth description of all of our definitions and also guidance notes to help customers understand what is covered under the definition. Top four claims declined under criteria not met are: Condition Heart attack of specified severity Stroke resulting in permanent symptoms Why these were not valid claims It is important to note that the term heart attack may sometimes be used loosely to describe a range of other heart conditions, but none of these other conditions (for example, angina) are covered under this definition. In addition, the medical profession has more than one definition of heart attack as the effects of advancing medical science are debated by the profession. However, we will only use the definition given in the plan to decide if a heart attack is covered. Stroke can be misdiagnosed when you first see a doctor. The symptoms of stroke are similar to other conditions and, in some cases, first impressions are not correct when you receive follow up care. Transient ischaemic attacks are not covered. These are attacks that produce temporary symptoms similar to a mild stroke but typically patients recover completely in less than 24 hours. Sometimes a transient ischaemic attack is called a mini stroke, which can cause confusion. Coronary Angioplasty Coronary Angioplasty was removed as a option in 2004 as this was no longer classed as a critical illness Therefore any policies taken out post 2004 claiming under this condition would be declined. In order to satisfy a claim under this condition for policies established before 2004 the following condition must be met in order for a claim to be paid: The undergoing of balloon angioplasty on the advice of a Consultant Cardiologist to correct narrowing or blockage of at least 70% in each of two or more coronary arteries. Therefore claims will be turned down if people who have undergone angioplasty where the narrowing was less than 70% in two or more arteries. Bladder cancer Cancer excluding less advanced cases Early bladder cancer is also called superficial bladder cancer or non muscle invasive bladder cancer. These are cancers that have been found very early in their development and would be classed as pre, low or borderline malignant or non-invasive. aviva.co.uk 11

12 Total permanent disablement Aviva s Critical Illness cover provides protection against over 30 different types of critical illness. One of the conditions covered is total permanent disablement. Our experience with this particular condition is that some claims are not paid because the claims criteria have not been met. We want to treat customers fairly and pay their claim. We ve provided some additional information below to help you understand how we treat claims for total permanent disablement. The checklist below provides you with some general principles about how we are likely to treat claims for this particular condition: Total permanent disablement: l Because some occupations are more physical than others (for example, builders, mechanics), our definition of total permanent disablement varies depending on your occupation at the time you take out the cover. The definition that applies to you will be determined by Aviva and stated on your policy schedule. You should check that this suits your needs. l depending on the definition that applies to you and your policy, we look at whether you - could carry out your normal occupation - may be unable to carry out specific activities of daily living for example, if you are able to wash yourself or independently go to the toilet l The definition of total permanent disablement will not change if you move jobs. However, if you retire or are not in employment immediately before your claim, then we will use the specified activities of daily living definition. l The symptoms from the condition leading to disablement is expected to be permanent with no expectation of improvement according to current medical knowledge and treatment options. Glossary of terms l Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. l Total disablement you cannot undertake the core activities and responsibilities involved in your normal occupation. If trivial/ non-essential components of the role cannot be undertaken, this would not constitute total disablement. l Normal occupation a trade, profession or type of work undertaken for profit or pay. It is not a specific job with any particular employer and is independent of location. 12 Aviva s Critical Illness claims report 2009

13 Examples: OPTICIAN An optician has developed severe visual problems herself, which prevents her from carrying out the main duties of her role. Her condition can t be treated and is not likely to improve. The definition provided when the policy was taken out was inability to perform own occupation. Her claim for total permanent disablement was accepted because her condition is expected to be permanent and it is preventing her from doing her job. Claim Accepted CASHIER A bank cashier suffers from long term back problems and has undergone several unsuccessful operations which attempted to correct his injury. The definition provided when the policy was taken out was inability to perform own occupation. His claim for total permanent disablement was accepted as he is unable to carry out the manual aspects of his job and his specialist has confirmed that he will always have problems with standing, sitting and lifting for any significant periods. Claim Accepted ADMINISTRATION ASSISTANT An administration assistant has had a history of depression due to a poor relationship with his manager and he has been off work as a result. Treatment has stopped and he is no longer suffering from any symptoms. The definition provided when the policy was taken out was inability to perform own occupation. His claim for total permanent disablement was rejected as he can return to a similar role with another manager or at a different company. Claim Rejected aviva.co.uk 13

14 real life claims examples In general, critical illness doesn t discriminate by age or gender as the examples below demonstrate: Claimant Age Reason for claim Amount ( ) Aged under 30 Female 22 Heart attack 83,219 Male 24 Benign brain tumour 84,126 Female 26 Cancer-uterus 113,026 Male 28 Cancer- kidney 107,059 Female 28 Multiple Sclerosis 47,844 Male 29 Cancer-testicular 85,647 Aged Female 30 Stroke 52,818 Male 30 Benign brain tumour 229,340 Male 32 Parkinson s before age 60 74,209 Female 33 Cancer-bone 94,336 Male 36 Heart attack 57,168 Female 38 Cancer-cervix 45,284 Aged Female 40 Motor neurone disease 57,707 Male 41 Heart attack 41,637 Male 42 Heart valve replacement/repair 84,164 Female 44 Stroke 60,247 Male 46 Cancer-tonsil 197,802 Female 49 Cancer-colon/rectum 86,359 Aged Female 50 Cancer-breast 37,190 Male 50 Cancer- prostate 20,324 Female 51 Cancer-kidney 36,388 Male 52 Coma 13,929 Female 57 Cancer-pancreas 22,560 Male 58 Cancer-larynx 97,010 Aged 60+ Male 60 Motor neurone disease 13,556 Female 60 Cancer-breast 7,094 Male 61 Heart attack 25,904 Female 62 Cancer-colon/rectum 38,536 Female 64 Stroke 18,298 Male 68 Cancer-colon/rectum 17, Aviva s Critical Illness claims report 2009

15 Why Aviva? Our Claims department believes that respecting and treating our customers as individuals and not just as the number from the policy document, is the best way to show we know what we are doing and truly value them. A word from Andrew our claims manager Being part of the Aviva Life Claims Team is a real privilege. It gives me the opportunity to help make a difference in what can be the most difficult time of our customer and family s lives. I have a highly trained team here in York, with each and every member being passionate about doing what is right for the customer providing peace of mind when they need us most. We continue to look for ways to make the claims experience as easy as possible through feedback we receive from our customers, which I am proud to say is excellent and demonstrates we are doing the right things. We have a one hour call back service on all CI Claims where we obtain the claim form details over the phone. This allows us to start the claim process immediately, removing the need for complicated forms and giving a tailored experience for each customer. Our customers tell us that it is important to keep in touch and let them know what is happening with their claim, so we have a range of communication methods to provide regular updates. If you have any queries regarding a claim, please contact us on aviva.co.uk 15

16 Aviva Life & Pensions UK Limited. registered in England No rougier Street, York, YO90 1UU. Aviva Life & Pensions UK Limited is authorised and regulated by the Financial Services Authority. Member of the Association of British Insurers. aviva.co.uk PT /2010 Aviva plc