Critical Illness Cover - What a Joke!

I was diagnosed 1st June 2009 and paid out 4 weeks later with one months interest on the money plus refund of 2 months premium!!! I cant believe how much insurance companies try and wriggle out of paying ci out, let us know how you get on

take care

Carol xx

Mine paid out no problem. There was a short delay when they were waiting for info from the docs. I had 2 policies from when we remorgaged and the 2 companies shared info. Mine was also in the the lymph nodes and that is classed as invasive.

Mine paid out immediately for critical illness policy but were a little reluctant to pay out on the terminal illness clause on my life policy. They paid out in the end though, but as it was decreasing term they probably saved some money in the delay.


Just wanted to add that if your insurance company are still refusing to pay out for suspect reasons, then you can litigate against them to make them pay out. There is a whole area of law which deals with insurance litigation and a judge can find in favour of a claimant who says that the company should be paying out and are breaching the terms of the insurance policy in not doing so. Its worth keeping records of everything you say to the company and get as much in writing as possible, because it always helps a bit to be able to prove when the company has treated you shabbilly, especially in these circumstances.

It is well worth decent research into finding a good solid firm to act for you as its not soemthing most high street solicitors are likely to be sufficiently experienced in to do your claim justice. If you are in a trade union, they may well fund you and arrange for a good firm to act for you. Occasionally,you may find appropriate legal cover on other policies you may have, like house insurance. Its not an easy route, but definitely something to bear in mind that the companys final decision doesn’t have to mean the end of the road.

And if they refuse you bacause you have changed your name without telling them, they are totally off the mark as there is absolutely no basis for this!

I had a critical illness policy with Scottish Provident and on reading old posts about how companies are reluctant to pay, I thought I’d have a fight on my hands. My GP also phoned me to tell me that because I’d seen a GP before taking the policy out with a dimple on the boob, that the insurance co. could say this was a symptom even before I was properly diagnosed and not pay out. When I first went with the boob dimple, the gp didn’t see it and therefore I wasn’t referred on at that stage.

But surprisingly, the company paid up and now we are now mortgage free. It took a while with statements having to be gathered from GP and surgeon. We also had our monthly payments refunded from the date of diagnosis too. We’d taken out the policy about 18 months before my diagnosis when negotiating a new mortgage.

I have just been reading a few posts in this section of the forum, and it has prompted me to ask for any comments or advise about whether I should try and claim on my life insurance policy.
I was diagnosed with secondary breast cancer in May. I have quite extensive bony secondaries, no liver or lung involvement. I have had some radiotherapy and am on bisphosphonates and Letrozole (which may or may not be having any effect possibly, but too soon to be sure).
My life policy is for a fixed term - until May 2011. I phoned them to ask them how ‘terminal’ was defined, and was told less than 12 months. I asked my macmillan nurse how the DLA application was worded as that defines it as 6 months. He said he words the claim 'wouldn’t be surprised if (name) were to die within the next 6 (12) months. I discussed this with my oncologist and he felt he couldn’t say this (which, of course, is probably good news for me!). I don’t understand though, how the DLA was approved on a 6 month definition under these circumstances. I wonder whether to ask my GP instead. My macmillan benefit officer suggested I try different doctors until I find one who says yes!
Any ideas??

This is v helpful. We cancelled criticalillness a yr prior to dx on financial advisors advice!!! However I am claiming on life based on terminal dx with my liver mets. Rang me Friday saying there is an entry in 2005 saying I was given smoking cessation advice which is bonkers as I have never smoked so now it’s my word against a gp entry. I left that gp as ge failed to act over 8 months on the symptoms. Repeatedly saw him about re breast cancer.

Called his practice who knew me and said that not only was I preg on the date stated but my records clearly show non smoker so they’re hinging it on tha one thing. Also guy at legal and general said they want my nex scan result as if it shows positive response to treatment they won’t pay anyway as it’s an accelerated death benefit and it’s unlikely I will die within year!!!

What can I say but my luck sucks. My pal claimed on my advice with aviva and got money at weekend. No questions and four weeks in all. She got scan last week showing massive reduction in cancer.

Lynn xxxxx

I can believe how reluctant insurance companies are to pay out. I have a good gp so I think I will talk to her about it. Fingers crossed!

I’m just about to put in my claim with Pru-only had our first flat for six weeks and only paid one premium on the policy so hoping it will pay out! I’m so worried it won’t! Have family who will help financially but the money will take away a huge weight! I’m not sure what I actually have yet until MRI and op but my insurance covers DCIS thankfully so fingers crossed! I think it is awful how they will find any way to get out of paying and, if that happens to me, will def pursue litigation as you do take these things out so they are there if you need them! I hope that everyones problems get sorted and these big multimillion conglomerates start thinking about the individual!!!

Good luck all!

Correction my insurance covers DCIS where mastectomy required - like mine! Had to double-check after reading everyones messages!


Further to my previous post, I found out today my insurance claim has been approved! It has taken Pru a day to assess the claim from receipt of my treating specialist’s form ANC I’m very pleased! Unfortunately I didn’t have DCIS so that was irrelevant but am covered for my cancer type. I hope other people have successful claims and be reassured it’s not always bad!


Glad to hear that things have worked out for you with this.


Hi all,

I sent off my claim form earlier this week but the lady I spoke to kept saying they wouldn’t pay for ‘cancer in situ’. Does anyone know what this means? To my mind, the cancer is not is situ as I had a mastectomy last week, so either it is gone, or else it has spread (I will find out this afternoon).

I have been paying premiums on my policy since 1995. They went up £2 a month each year, so the current premium is £50 per month - which I think is a lot if they don’t pay out now.

Hello Nottsgal

Welcome to the forums, I’m sure other users will be along to support you soon.
In the meantime you may find it useful to contact our free helpline on 0808 800 6000 and ask about ‘cancer in situ’ as they will be able to explain it to you, opening hours are Monday to Friday 9.00 – 5.00 and Saturday 9.00 – 2.00.

I have also attached a link to our publication on Ductal Carcinoma in Situ

Best wishes
June, moderator

Nottsgal cancer in situ usually means it is non invasive and an early stage tumour.

Critical illness cover was designed to pay out for serious illnesses that may require a long recovery time and extensive teratment. In the case of cancer, it depends on the grade and spread. If you ask your insurer they should be able to provide you with a booklet that goes into detail about their definitions for each illness they cover.

Please don’t take this post as belittling your experience in any way, shape or form because any cancer diagnosis is obviously very serious and concerning for the person involved. I am trying to explain it from an insurer’s point of view, not a patients if you see what I mean.


Thanks June and Alibabes, and yes I am probably thinking that since something nasty has happened, the insurance company should give me some money to make me feel a bit better about it all ;0). I know really that it doesn’t work like that!

I got the results yesterday and the cancer had been upgraded from a 1 to a 3 (v aggressive) but had not spread to the lymph nodes, so I’m lucky compared to many. The bad news was that because of the upgrade I will have to have chemotherapy, then radiotherapy, then herceptin, then tamoxifen (unless chemo brings on early menopause, in which case it will be aricept).

nottsgal sounds like your cancer is invasive and not in
situ as invasive cancer gets graded 1, 2 and 3 but in situ is usually referred to as low, intermediate and high grade.

so most insurers will pay out for invasive cancer and most wont pay out for DCIS (although as Emma has stated a few will pay out if you fit other criteria).


Thanks Lulu,
I didn’t know that.

I can see this forum is going to be great for getting to know all sorts of stuff. I’ll try to be helpful to others who ask things but I don’t know much yet. 6 weeks ago I didn’t even know I had cancer.

I am getting a payout from the critical illness insurance (Reliance Mutual). I am pleased but haven’t told anyone, other my husband of course, as I don’t want people thinking I’m rich, or lucky to have so much money fall into my lap. But I can tell the people on here :0)

Hi Nottsgal
I too got a payout and didn’t mention it to anyone other than my husband. Only one friend actually asked about it directly and I was honest with her.