How to claim on your critical illness cover

Written by Dom James, Financial Content Writer

14 December 2018

If you are diagnosed with a life changing condition, a successful critical illness claim can help take the financial strain off your recovery. Here is how to make a claim.

Concerned couple at home with bills and laptop

You will not be able to claim if you are diagnosed with a condition caused by alcohol or drug abuse.

Get diagnosed

Once a doctor diagnoses you with a condition covered in your critical illness policy, contact your insurer immediately.

If you attempt to make a fraudulent claim, or a claim based on a self diagnosis, your policy will get cancelled.

This is why choosing the right policy is so important. If you try to claim for a condition excluded from your policy, you will not receive a payout.

Each policy covers a set number of conditions, but will vary depending on your insurer. A common policy may exclude advanced cases of cancer, Alzheimer's disease that does not result in permanent symptoms, early stage liver failure, temporary paralysis of a limb or even third degree burns covering less than 20% of your body's surface area.

Check your policy document before you apply to understand the level of cover you are taking out.

Contact your insurer

Contact your insurer as soon as possible after getting your diagnosis. They will tell you what next steps to take for your claim to be successful.

You can find your insurer's contact details in your critical illness policy document, or by visiting their website and clicking on their contact page.

Your insurer will then confirm if your condition:

Is covered, then you can start your claim
Is not covered, then you will not be able to make a claim

Even if your policy does not cover your condition, you should tell your insurer so they can update your details. If you do not tell your insurer, then your policy may become invalid.

The cost of critical illness cover and the level of insurance you need depends on your personal health, therefore it is crucial to be open and honest with your insurer. If not, you may not get a payout when you need one.

If your insurer rejects your claim but your policy states that your diagnosed condition is covered, contact the Financial Ombudsman Service for further support.

Start a claim

When you speak to your insurer it is important to give honest responses to any questions they ask. If you do not, you could invalidate your policy and lose your chance to claim.

You will need to give your insurer access to your medical records, so that they have evidence of your condition and how severe it is.

Your insurer will send paperwork for you to confirm the details of your claim. You have to send this back to them with your signature before they can process your claim.

Get your payout

You will get your payout money after your insurer has verified your documents and checked your medical records.

You will have the chance to choose which account your payout goes to when you complete the paperwork for your claim.

Your critical illness policy ends after you make one successful claim.