What is critical illness insurance
Critical illness insurance is designed to pay out if you get one of the serious illnesses listed under your policy. If you’re diagnosed with an illness covered by the policy, you’ll be paid a lump sum to help you while you recover. Permanent and total disability benefit is often offered as part of this cover.
The types of illness covered will depend on your policy. All policies will include:
- heart attack
Some policies might not cover all types of these illness, so you’ll need to check the terms of the policy you take out.
Types of complaints we see
Consumers may complain to us that:
- They’re unhappy with how their policy was sold to them – for example they don’t think the cover was fairly described in the marketing materials
- They’re unhappy with the way the insurer has assessed their claim – for example, the insurer says their illness isn’t covered by the policy
- Their insurer won’t pay the claim because they didn’t disclose certain information when they took out the policy
- The insurer took too long to pay their claim, or other customer service issues
What we look at
When we investigate your complaint we’ll:
- look carefully at the type of policy you have
- take into account the circumstances of your case, and the evidence from both sides, including medical evidence
- check that your insurer has followed the Association of British Insurers (ABI) guidelines and been clear about what your policy does and doesn’t cover
We’ll listen to both sides of the story and investigate the facts before making a decision.
How to complain
Talk to your insurance provider first as they need to have the chance to put things right. They have to give you their final response within eight weeks for most types of complaint. If you’re unhappy with their response, or if they don’t respond, let us know.
Find out more about making a complaint.
Putting things right
If your insurer rejected your claim but we decide your illness falls within the policy’s definition of a listed critical illness or permanent and total disability, we can tell your insurer to pay the claim with interest.
If we think it’s likely that your policy was mis-sold, we might tell your insurer to cancel the policy and refund the premiums with interest.
If we find that your claim was unnecessarily delayed, we may tell your insurer to pay you compensation to reflect the distress and inconvenience you’ve suffered.
Find out more from on guidance on compensation for non-financial loss.
Policyholder complains when her insurer rejects claim for total and permanent (TPD) benefit
Consumer is unsatisfied about rejected claim for critical illness cover
Consumer complains that policy should pay out for similar condition even if not listed
Advice for businesses
You’ll find more detailed information on our approach to complaints about critical illness cover in the ‘Handling a complaint’ section of our website.