Life and Critical Illness Insurance
The most typical cause for an insurer to deny a claim on life or critical illness insurance is failure to provide facts, mainly medical information. We want to tell you a genuine tale to help highlight specific difficulties, but we've changed the policyholders' names and a few other details to maintain privacy.
Mrs. A suffered a secondary infection after having malignant lymph nodes in her groin removed when she got further awful news. Her critical illness insurance company refused to pay her the £200,000 she was due.
It's helpful to know how the events transpired to comprehend why they happened and the challenges they raised.
Mrs. A went to the doctor in June 2020 after noticing a patch of dry skin on her back. Mrs. A assumed she had eczema. Her GP decided it needed to be looked at during a quick session and suggested she see a dermatologist. However, the flaky skin healed quickly, and Mrs. A was able to cancel her dermatologist appointment. Mrs. AP's GP reportedly expressed no substantial concern and subsequently stated that she was most likely ignorant of the urgency of the referral.
Nine weeks later, a Standard Life sales representative paid Mrs. A a regular call at her house. Mrs. A's life insurance policy was examined, and she was advised to add a £200,000 Critical Illness policy since she was now single with a young family. Mrs. A agreed right away since she thought it seemed like a great idea.
The salesperson took out the form and went through it with Mrs. A, question by question, noting down her replies. Mrs. A questioned the sales representative about what Standard was asking for when it came to requiring Mrs. A to divulge all instances in which her GP had advised referrals for testing or treatments. Mrs. A claims that the agent told her that Standard only wanted information about appointments with severe illnesses. Mrs. A didn't think her recommendation for what she believed was eczema fit into that category. Therefore she didn't say anything about it. She then signed the paper, sure that she had provided all of the information that Standard Life had requested.
Standard approved her application and granted a £200,000 Critical Illness Insurance coverage.
Mrs. A was diagnosed with skin cancer two years later. The malignancy was quickly removed by major surgery. Mrs. A filed what she felt was a reasonable claim since her critical illness coverage covered her cancer.
Mrs. A's claim was later denied by Standard Life due to "reckless non-disclosure," the insurers' euphemism for Mrs. A's failure to mention her canceled dermatologist visit.
The Problems
The following events demonstrated that Mrs. A's application should have included a dermatologist’s recommendation. So why didn't she tell anybody about it?
Two factors seem to have collaborated to generate the situation: Mrs. A was advised by a Standard Life salesperson that the question on the application form about "all instances her GP had sent her for testing or treatments" only applied to severe diseases. That interpretation was utterly incorrect. ALL OCCASIONS were asked in the question. These questions are carefully written, and ALL means ALL - the applicant is not being asked to make a personal judgment about whether the referral reasons were significant. The representative was mistaken.
Second, Mrs. A's GP seems to have been unaware of the significance of her flaking skin and her referral to a dermatologist. Mrs. A may hardly be held liable for not sharing such information if she was uninformed that her illness was possibly severe when she filled out the insurance application. The representative said that the referral question only applied to extreme conditions.
IN OUR OPINION, Mrs. A is not to blame and based on the facts supplied to us. The salesperson from Standard Life made a critical mistake. He provided inaccurate advice on what the dispute's central question was asking for. Standard Life, in our opinion, should make a payment.
What if Critical Illness claim declined? You must meet the concerned person to resolve it.
The lessons that must be learned
Always read each question on an insurance application form carefully before answering it entirely and accurately. Don't be tempted to cut corners when it comes to the truth. If you fail to provide what they want, the insurance company might allege that you lied to them by omission. Never feel compelled to withhold facts to qualify for a lower insurance rate. You could obtain a lower premium, but it's a waste of money if a later claim is denied.
Circumstances beyond her control duped Mrs. A. Therefore, we hope she receives her compensation. We feel she behaved in good faith. She is deserving of her reward, as well as our warmest wishes.
Those who intentionally hide information from their insurer or offer false information, on the other hand, do not.
Postscript: According to reports, Standard Life rejects 5% of all Critical Illness claims because of non-disclosure. Other insurers have higher rejection rates, such as Legal & General (16%) and Friends Provident (15%). The insurance industry is attempting to remedy this problem by changing how they get information from applicants and how they explain the consequences of non-disclosure.
Mrs. A suffered a secondary infection after having malignant lymph nodes in her groin removed when she got further awful news. Her critical illness insurance company refused to pay her the £200,000 she was due.
It's helpful to know how the events transpired to comprehend why they happened and the challenges they raised.
Mrs. A went to the doctor in June 2020 after noticing a patch of dry skin on her back. Mrs. A assumed she had eczema. Her GP decided it needed to be looked at during a quick session and suggested she see a dermatologist. However, the flaky skin healed quickly, and Mrs. A was able to cancel her dermatologist appointment. Mrs. AP's GP reportedly expressed no substantial concern and subsequently stated that she was most likely ignorant of the urgency of the referral.
Nine weeks later, a Standard Life sales representative paid Mrs. A a regular call at her house. Mrs. A's life insurance policy was examined, and she was advised to add a £200,000 Critical Illness policy since she was now single with a young family. Mrs. A agreed right away since she thought it seemed like a great idea.
The salesperson took out the form and went through it with Mrs. A, question by question, noting down her replies. Mrs. A questioned the sales representative about what Standard was asking for when it came to requiring Mrs. A to divulge all instances in which her GP had advised referrals for testing or treatments. Mrs. A claims that the agent told her that Standard only wanted information about appointments with severe illnesses. Mrs. A didn't think her recommendation for what she believed was eczema fit into that category. Therefore she didn't say anything about it. She then signed the paper, sure that she had provided all of the information that Standard Life had requested.
Standard approved her application and granted a £200,000 Critical Illness Insurance coverage.
Mrs. A was diagnosed with skin cancer two years later. The malignancy was quickly removed by major surgery. Mrs. A filed what she felt was a reasonable claim since her critical illness coverage covered her cancer.
Mrs. A's claim was later denied by Standard Life due to "reckless non-disclosure," the insurers' euphemism for Mrs. A's failure to mention her canceled dermatologist visit.
The Problems
The following events demonstrated that Mrs. A's application should have included a dermatologist’s recommendation. So why didn't she tell anybody about it?
Two factors seem to have collaborated to generate the situation: Mrs. A was advised by a Standard Life salesperson that the question on the application form about "all instances her GP had sent her for testing or treatments" only applied to severe diseases. That interpretation was utterly incorrect. ALL OCCASIONS were asked in the question. These questions are carefully written, and ALL means ALL - the applicant is not being asked to make a personal judgment about whether the referral reasons were significant. The representative was mistaken.
Second, Mrs. A's GP seems to have been unaware of the significance of her flaking skin and her referral to a dermatologist. Mrs. A may hardly be held liable for not sharing such information if she was uninformed that her illness was possibly severe when she filled out the insurance application. The representative said that the referral question only applied to extreme conditions.
IN OUR OPINION, Mrs. A is not to blame and based on the facts supplied to us. The salesperson from Standard Life made a critical mistake. He provided inaccurate advice on what the dispute's central question was asking for. Standard Life, in our opinion, should make a payment.
What if Critical Illness claim declined? You must meet the concerned person to resolve it.
The lessons that must be learned
Always read each question on an insurance application form carefully before answering it entirely and accurately. Don't be tempted to cut corners when it comes to the truth. If you fail to provide what they want, the insurance company might allege that you lied to them by omission. Never feel compelled to withhold facts to qualify for a lower insurance rate. You could obtain a lower premium, but it's a waste of money if a later claim is denied.
Circumstances beyond her control duped Mrs. A. Therefore, we hope she receives her compensation. We feel she behaved in good faith. She is deserving of her reward, as well as our warmest wishes.
Those who intentionally hide information from their insurer or offer false information, on the other hand, do not.
Postscript: According to reports, Standard Life rejects 5% of all Critical Illness claims because of non-disclosure. Other insurers have higher rejection rates, such as Legal & General (16%) and Friends Provident (15%). The insurance industry is attempting to remedy this problem by changing how they get information from applicants and how they explain the consequences of non-disclosure.
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