Critical Illness Claims Report 43,303,919 out in critical illness claims in the first six months of 2012* 60 % Cancer 16 % Heart Attack 10 % Other 3 % Benign Brain Tumour 5 % Multiple Sclerosis 6 % Stroke *Scottish Provident critical illness claims 1 January to 30 June 2012.
Critical illness claims report At Scottish Provident we pride ourselves on providing quality cover and a proven track record for claims. This report details our critical illness claims in the first half of 2012. It details the illnesses which led to the claims, provides reasons why some are not and also gives guidance on how you can help your clients ensure that their claim is. What is critical illness cover? Critical illness cover pays out if your clients suffer a critical illness, listed within the plan, which meets our definition. This form of cover can be taken out on a level, increasing or decreasing term basis and is available for a fixed or renewable term. Why is it important? For most of us, the importance of having critical illness cover in place does not become clear until we need to make a claim. But it is not just about having the right amount of cover in place. It is about having quality cover, offering peace of mind to planholders and cover that will pay out when it is needed. Our claims statistics At Scottish Provident, we believe it is important to be open about our critical illness claims. We want to be able to pay out to your clients when they make a claim helping them in their time of need. Please note that these statistics do not include children s critical illness claims. These are reported individually on page 3. claims January - June 2012 amount 43,303,919 number of claims 511 % of claims (as a % of total claims) 93% Average payout 84,743 Largest claim value 1,000,000 Average age of claimant 49 Average time period in force before claim 9 years 1 month Un claims January - June 2012 number of un claims 37 % of un claims (as a % of total claims) 7% Number of claims declined because the illness suffered did not meet our critical illness definition Number of claims which resulted in no payment owing to the discovery of material non-disclosure at the time the plan was taken out. These plans were cancelled with the premiums refunded 25 (5%) 12 (2%) 2
Children s critical illness breakdown No one likes to think of their child becoming critically ill, but it is an unfortunate reality. At Scottish Provident we give your clients financial peace of mind by covering their children for critical illnesses. Our experience with children s claims is that thankfully, their ailments are often not critical, nor do they produce lasting symptoms, which explains the high percentage of un claims for children s critical illness. claims January - June 2012 amount 374,375 number of claims 20 % of claims 87% Average payout 18,719* Average age of claimant 8 Average time period in force before claim 7 years, 5 months Un claims January - June 2012 number of un claims 3 % of un claims 13% Did not meet definition 3 (13%) This money could help provide the best care and support for a sick child and allow their parents the financial freedom to change their working patterns in order to look after them. Children s critical illness is our 5th highest claim category. * Children s critical illness pays out the lesser amount of either 20,000 or 50% of your client s main critical illness cover amount. ** Scottish Provident critical illness claims figures 1 January - 30 June 2012. 374,375 out in children s critical illness claims in the first half of 2012** 3
Critical illness claims report Claims summary All Claims Male Female Cause of CI claim No. of claims amount % of total No. of claims amount % of total No. of claims amount Average age at claim Average number of months in force before claim Cancer 308 25,038,326 41% 125 10,413,799 59% 183 14,624,527 48 107 Heart Attack 80 5,622,061 91% 73 5,301,881 9% 7 320,180 51 106 Stroke 33 2,387,405 85% 28 2,068,546 15% 5 318,859 52 114 Multiple Sclerosis 27 3,725,153 37% 10 2,122,178 63% 17 1,602,975 43 106 Benign Brain Tumour 14 1,324,883 50% 7 616,942 50% 7 707,941 47 104 Coronary Artery By-Pass Grafts 14 1,183,542 100% 14 1,183,542 0% 0 0 56 158 Parkinson's Disease 9 878,655 67% 6 651,490 33% 3 227,165 52 137 Heart Valve Replacement or Repair 6 1,145,235 83% 5 1,065,235 17% 1 80,000 49 97 Angioplasty 5 259,249 100% 5 259,249 0% 0 0 51 149 Aorta Graft Surgery 4 808,701 100% 4 808,701 0% 0 0 57 130 Motor Neurone Disease 2 200,026 100% 2 200,026 0% 0 0 50 119 Traumatic Head Injury 2 270,370 100% 2 270,370 0% 0 0 25 62 Major Organ Transplant 2 186,140 50% 1 115,476 50% 1 70,664 52 139 Other* 5 274,173 60% 3 46,974 40% 2 227,199 45 88 TOTAL 511 43,303,919 56% 285 25,124,409 44% 226 18,179,510 49 109 * This category includes other critical illness definitions where only single claims have been. Please note, TPD and terminal illness are not included within these claims figures. We do not cover all critical illnesses including some types of cancer. For further information on our products, including any exclusions and limitations, please see our product literature. Claims by age 24 % 45-49 Age group No. of claims amount 16 % 40-44 Less than 29 9 790,157 30-34 17 1,273,816 35-39 46 4,896,825 40-44 84 7,242,298 45-49 122 11,127,186 50-54 107 7,764,685 55-64 112 8,790,410 Older than 65 14 1,418,542 TOTAL 511 43,303,919 9 % 35-39 3 % 30-34 2 % <29 3 % >65 22 % 55-64 21 % 50-54 4
Cancer claims summary Type of Cancer No. Of Claims All Claims Male Female Amount % of No. Of Claims Amount * This category includes other types of cancer where only single claims have been. % of No. Of Claims Amount Average Age at Claim Average number of months in force before claim Breast 106 8,663,945 0% 0 0 100% 106 8,663,945 47 109 Bowel/Colon 35 2,789,313 69% 24 2,018,853 31% 11 770,460 48 110 Malignant Melanoma 24 2,029,128 54% 13 1,148,482 46% 11 880,646 46 90 Prostate 22 1,886,793 100% 22 1,886,793 0% 0 0 58 133 Thyroid 12 1,181,634 17% 2 51,578 83% 10 1,130,056 41 91 Leukaemia 12 1,065,647 83% 10 1,012,715 17% 2 52,932 50 117 Testicular 9 880,378 100% 9 880,378 0% 0 0 38 77 Cervical 9 808,605 0% 0 0 100% 9 808,605 40 95 Lung 8 558,166 63% 5 387,162 37% 3 171,004 54 104 Ear/Nose/Throat 8 530,042 75% 6 331,042 25% 2 199,000 53 130 Ovarian 7 371,382 0% 0 0 100% 7 371,382 48 109 Brain 6 307,691 33% 2 62,901 67% 4 244,790 47 95 Pancreas 6 447,993 100% 6 447,993 0% 0 0 48 91 Lymphoma 6 751,205 33% 2 432,894 67% 4 318,311 53 122 Kidney 4 387,193 75% 3 366,041 25% 1 21,152 48 103 Oral 4 243,561 100% 4 243,561 0% 0 0 51 118 Hodgkin's Lymphoma 3 210,776 67% 2 205,606 33% 1 5,170 41 100 Liver 3 172,353 67% 2 150,627 33% 1 21,726 56 111 Gastric 3 397,515 0% 0 0 100% 3 397,515 43 122 Oesophagus 3 143,489 100% 3 143,489 0% 0 0 51 113 Sarcoma 3 251,028 100% 3 251,028 0% 0 0 50 112 Uterus 3 164,720 0% 0 0 100% 3 164,720 51 92 Non-Hodgkin's Lymphoma 3 211,842 0% 0 0 100% 3 211,842 51 150 Glandular 3 129,295 67% 2 79,295 33% 1 50,000 34 61 Bladder 2 141,714 100% 2 141,714 0% 0 0 47 16 Other* 4 312,918 75% 3 171,647 25% 1 141,271 48 127 TOTAL 308 25,038,326 41% 125 10,413,799 59% 183 14,624,527 48 107 5
Critical illness claims report Financial support at a time of need the facts At Scottish Provident, we are always looking for ways to make things better for you and your clients. In January 2012 we over 79,000 to a financial adviser who had breast cancer the plan had only been in force 6 months. In January 2012 we over 175,000 to a dentist who had suffered a heart attack the plan had only been in force 12 months. In February 2012 we over 890,000 to a high court judge who had keyhole heart surgery. In February 2012 we over 355,000 to a surgeon who had multiple sclerosis. In May 2012 we 250,000 to an estate agent who had suffered a stroke. If your clients stop paying premiums they will not get anything back, their plan will stop and they will no longer be covered for their benefits. Premiums should continue to be until a decision has been reached on a claim. Plans have no cash in value at any time. Over 1billion in critical illness claims since 1996. 6
How you can help us pay claims We know that your clients have taken out critical illness cover to provide some peace of mind in the event of developing a critical illness. Our aim is to pay valid claims as promptly and efficiently as possible. We always assess claims in a fair and consistent way. However, there may be occasions when claims are not because of non-disclosure or if a claim does not meet any of our critical illness definitions. What do we mean by non-disclosure? Non-disclosure occurs before the plan starts, i.e. if your clients fail to fully disclose anything that may be of relevance to the questions on their application form. This may include a detail in their past medical history, which seems unimportant to your clients at the time however, we would rather they gave too much information than too little, allowing us to decide what is important. If, while assessing a claim, it is established that there has been non-disclosure which would have affected the terms on which we would have accepted the case, then the sum assured would be altered to reflect those terms. If the benefit would have been declined then no payment would be made. Help your clients to avoid non-disclosure In order to help your clients as much as possible: Highlight the importance of giving full details of their medical history at application stage. Make sure that all questions on the application form are answered fully. It is far better to give more information than not enough. Your clients may wish to speak to their doctor before making the application if they are unsure about any details. We continue to make improvements to our application form, in order to prompt your clients to give as much information as possible. This should further assist you in ensuring full-disclosure and in delivering a better service for your clients. A 51 year old female claimed under the multiple sclerosis definition. However, the claimant failed to declare on their original application a history of intermittent blurred vision which was investigated in hospital. A claim was made by a 62 year old male for a heart attack. However, the claimant failed to declare that they were a heavy smoker despite being directly asked on their application. A claim was made by a 46 year old female under the kidney failure definition. Evidence later determined that the claimant had been diagnosed with a polycystic kidney disease prior to the application. 7
What do we mean by does not meet critical illness definitions? We aim to cover many of the life-changing illnesses that would require your clients to make significant adjustments to the way in which they live their lives. We will not pay a claim for any illness not included within our list of definitions and we urge you and your clients to be fully aware of this. However, our claims process enables your clients to request a claim form even when their illness is not specifically covered by the plan. This enables us to assess whether the claim can be under any of the conditions covered, in other words leaving no stone unturned. We could reduce the number of un claims under the does not meet definition heading if we filtered out grey claims at the initial telephone stage. But we believe our process is treating customers fairly, which outweighs our desire to produce low declinature rates under this heading. The following claims were not out, as they did not meet the plan definitions: A claim was submitted by a 56 year old male under the angioplasty definition. Medical reports confirmed that the procedure had only been carried out to one artery, not two as required by our definition. A 65 year old male claimed under the benign brain tumour definition due to a macroadenoma of the pituitary gland. However, tumours that occur in the pituitary gland are not covered by our definition. Here to help you Underwriting support Helpline 0845 602 0123 Claims support Helpline 0845 271 0007 Please note that we do not cover all illnesses, including some types of cancer. For more information, refer to our definitions guide or product literature for details on the illnesses we cover and any exclusions that may apply. Visit www.scottishprovident.com for more information, or call our sales team on 0845 300 0005. Scottish Provident is a division of the Royal London Group which consists of The Royal London Mutual Insurance Society Ltd and its subsidiaries. The Royal London Mutual Insurance Society Ltd is authorised and regulated by the Financial Services Authority No.117672 and is registered in England and Wales No.99064. The registered office is 55 Gracechurch Street, London, United Kingdom EC3V 0RL. SCPR5658 AUG12 LD