Case Study

Critical Illness Cover – A Lifeline During a Medical Crisis

Service provided:

Life and Critical Illness Cover & Claims Support

The challenge:

Our client a 29-year-old banker, had recently married and purchased her first home. Along with her mortgage, she had taken out Life and Critical Illness cover as well as Income Protection, ensuring she was financially protected in case of unforeseen circumstances. In September last year, Karen’s life took an unexpected turn when she was diagnosed with borderline malignancy of the ovaries following a routine biopsy.

Having taken out her insurance policy years earlier, Karen wasn’t sure if her diagnosis qualified for a claim under her Critical Illness cover. She was under the impression that only terminal illnesses could trigger a payout, leaving her uncertain about her financial protection at a time of medical and emotional turmoil.

The solution:

The client’s insurance policy included £100,000 whole of life cover with Critical Illness protection, for which she was paying an annual premium of £420. Unsure if her condition would allow her to make a claim, she consulted with her financial adviser, who played a crucial role in guiding her through the claims process.

Policy Review & Clarification:

Our client initially believed her policy wouldn’t pay out as her cancer was not terminal. However, her adviser reviewed the policy and explained that Critical Illness cover did not require the illness to be terminal. The policy wording was based on a confirmed diagnosis of certain medical conditions, and fortunately, Karen’s ovarian malignancy fell within the scope of covered illnesses.

Initiating the Claim:

In October, following her first surgery to remove one of her ovaries, Karen contacted her insurance provider’s claims team. The insurer sent her a claim form, which she promptly completed and returned.
The insurer then communicated directly with Karen’s GP and consultant to obtain all necessary medical documentation. The communication between the parties was smooth, and Karen’s adviser stayed involved throughout, ensuring no delays or miscommunication occurred.

Claim Support:

Karen’s adviser regularly followed up with her GP, consultant, and the insurance provider, making sure that the claims process was as straightforward as possible. His proactive approach helped avoid the common delays and frustrations that people often experience when making insurance claims.

The results:

By December, the client received confirmation that her Critical Illness claim was successful, and a cheque was sent to her shortly thereafter. This payout provided her with financial relief and support during a highly stressful period, allowing her to focus on her recovery without worrying about financial burdens.

Successful Claim: Despite initial doubts, our client’s Critical Illness cover paid out in full, helping her cover medical expenses and secure her financial future as she continued her treatment.
Seamless Claims Process: With the support of her adviser, the claims process went smoothly and quickly, with the insurance provider approving the claim within weeks of her initial application.
Client Satisfaction: Our client was deeply grateful for the proactive support she received, which helped her avoid the usual pitfalls and delays often associated with insurance claims.