Critical illness policy - problems with claims

Has anyone had problems claiming under their critical illness policy?
My insurance company is contacting my Dr again to ask about my smoking history. I started smoking about 5 years ago, long after we took out this policy, and I am wondering if they will not pay out as a result, although there is no connection between smoking and breast cancer.

I was a smoker and had no trouble receiving my pay out.(although it was on my doctors record that I had given up 18 months previously- I restarted when I was diagnosed!)
My policy was with Legal and General.
Good luck with your claim

ps- treatment ended in November and have since given up again!

Hi there,

I was turned down due to smoking history. I stopped when I was pregnant and wrote this on my policy application. Scottish Provident went through my medical records with a fine tooth comb and turned down my claim saying there was a discrepancy between the dates I had given for stopping smoking and that a previous case of appendicitis had been found to involve a cancerous tumour (hospital never told me this) which I had not declared. So I am now £100k poorer. My premiums were returned and in my bank account before I received the letter from them. I would have contested it at the time but having been diagnosed with 2ndaries I didn’t have the energy for the fight. I know that there has been a lot of publicity about critical claims so be careful, they can be horribly picky. I am still smarting about basically being called a liar by them.

Best of luck,



I have a claim ongoing, and it feels like it’s taking forever. I know that they’ve had the report from my consultant and are waiting for my GP, so it is very frustrating.
I think that they should point it out in the small print if smoking means they’re not going to pay for certain conditions, and the person selling you the policy should also point it out.

Good luck with your claim


Go with policy to your local CAB for help with pursuing your claim. They have loads of experience and can help you make a complaint if appropriate.

Good luck
Sue xx

We had 2 policies linked to our mortgage which was in 2 parts also. 1 policy we had had for several yrs, but as we had recently moved house and re-mortgaged, I shopped around and got a much cheaper deal. So when I was diagnosed, we had only had the policy for 6 weeks. It was with Scottish provident. The 1st policy paid out within days. The one with SP, took ages to finalised, and they kept bothering my GP for extra info.

They did eventually pay up and also re-paid our monthly mortgage payments from diagnosis to completion. It was pretty stressful though. I’m affraid I am a non-smoker but if there is no proven link what is their argument?

Hope you have good luck too.


Thanks for all your responses - Scottish Provident mentoned 3 times makes me wonder if it is just them.
The latest is a request to my Dr is for information about my history of depression!
After 3 months off work, this month will be the 1st we will not be able to pay the mortgage.
I am getting really annoyed with them now, but it is taking my mind off my 1st chemo tomorrow.

Jennywren - I am really sorry you were not up to fighting at the time. Your story angered me and I wanted to tell the world what b******* they are.
What we need is for someone with the knowhow to take up these cases on our behalf and to let people know about them before they sign up to policies like this.


I chose Scot Prov because statistically they paid out more than any other so could just be a co-incidence on here. While you are waiting for it to be settled, can you take a mortgage holiday? Some companies offer this in their small print and I only found out I could do this after phoning up to say I would be unable to pay the next month. That was with Alliance & Leicester and they were great, very sympathetic.

Jennywren, my sister in law who is a nurse says you should appeal and get notes from hosp so you can see for yourself wether or not the Doc told you, or claimed to tell you, about this earlier tumour. Also, Did your gp get informed? And is there anything in their notes about it.

Can you get CAB to fight on your behalf if you are not up to it? Seem wrong that they should keep whats rightfully yours.

Good luck to you both.


Thankyou for this, Irene. My partner and I were discussing whether or not to have a go at appealing, only last night.

I will try and follow up your suggestions.

Many thanks,


Just a brief word of warning.

I have a mortgage payment protection policy and the insurance company said I could cancel my direct debit and they would pay my mortgage each month. When I did this my mortgage lender said if my mortgage payment was even a day late it would affect my credit rating and could cause problems when applying for credit in the future.

I have left my direct debit in place and my mortgage gets paid twice each month and I have to wait for a refund… Rediculous!!!



These critical illness policies are notorious for not paying out and picking through claims…what relevance does depression have to breast cancer?

I am posting this link-if you are not happy with what has happened you can complain to the regulator…I Hope the moderators do not delete this as it is a link to the financial services authority.

I would urge everyone to pursue their claims if they feel they have a case. i know its easy for me to say but my personal experience with insurers since being diagnosed with secondaries is that they try it on, and then they try again. If they have made a deliberate mistake you may be able to correct them.


jacqc, that is what I had to do, but managed to get a mortgage holiday for part of it.


i’m still having bother with scottish provident. they found a discrepancy with my stopping smoking. i stopped in about march 2000 and in my medical records it says i stopped december 2000. we took the policy out in july 2001, i gave the agent all the details he asked for to the best of my knowledge and never deliberatly held any info back. if i had something to hide i would not have ok’d them access to my medical files. they have not refused us yet, they are still digging for more and more info - do they want blood! this whole thing is not helping me it is making me ill. my OH contacted the ombusmen and because we haven’t been refused they can’t help yet, but they have given some advice and my OH says they were really helpful. when we phoned scottish provident to ask what additional info they wanted they would not help and that was 2 different people we spoke to on the phone. the whole thing is rediculious.
i think that when you take a policy out they should send a copy to your gp to undersign to say that you have given the correct info so if you do need to claim it would be more straight forward.

p.s i haven’t smoked for 8 years now

Vodka - were you given a copy of your original application form?
We weren’t and didn’t think to ask for it at the time.
I would have answered any question truthfully, so if asked if I suffered from depression, this should be on their records.
When did you make your claim from = date of diagnosis?
Mine was 1st April, so now 10 weeks since.

hi adejude - no i was never given a copy of our application form.
the agent asked the questions and we told him the answers and he wrote them down. we answered all questions honestly.
i made my claim in march when i was dx.

i think they are now questioning things that happened after we took out the policy. i’e a mammogram i had about two years later. even although it was clear.

Great News!
The Insurance Company paid out this week.
Hang on in there all you ladies that have been waiting ages - it took Scottish Provident 3 months and several letters to and from my Dr
Jennywren, I hope you were able to start your appeal.
Love to all

Hi Ladies,
Please can somebody help me?
My life insurance started out by saying ‘we will pay out in case of death or permanent disability’ on the annual statements (I’ve had it for about 18 years). For 3 years in 2003/5 it said ‘we will pay out in case of death or critical illness’ and since then it has said ‘in the event of death, permanent disability and/or critical illness’.
I now have secondaries and am making a claim but they are saying that I have never been covered for critical illness, as it’s not in the small print of my policy. I have written back to ask why it said ‘critical illness’ on my statement then, for three years running, and they wrote back to say it was misleading, and suggest I make a formal complaint.
They have sent me the papers to make a complaint, but I’m just not sure if they are trying to shift me away from dealing with the claims dept, to dealing with the complaints dept, and therefore I will never get a claim accepted. Should I keep on pushing the claims dept, or do as they say and start a complaints process.
Needless to say, my prognosis is not good, they are going to have to pay out sooner or later anyway, and I would rather not spend my precious time fighting this.
Any advice gratefully received
Best wishes

Hi Jacksy,

Sorry to hear about your problems with your insurance claim. If you would like to give the helpline a call they may be able to advise as to where to go from here. Also the Citizens Advice Bureau (CAB) will be a good place to get reliable information, you should have an office local to you. The phone number for BCC helpline is 0808 800 6000, open again Monday - Friday 9am - 5pm, Sat 9am - 2pm.

Hope this helps.

Kind regards,
Jo, Facilitator

Hi jacquie

its ridiculous hearing your story - the nerve of the company-(my own claim was rejected, but this is my employers fault really- long story)

I dont think you will get anywhere with the claims department. I think you should make the complaint and then also send them a letter saying you are writing to your MP, the Daily Telegraph and the Daily Mirror. Then once you receive a reply take it to the Financial Ombudsman.

I understand why you want to resolve this now - you want to know that your family has the money and you can quit paying the premiums. i think the company should be ashamed of themselves -

take care

The issue of life insurance and critical illness insurance is affecting many ladies with breast cancer, so could Breast Cancer Care help here with a story for the media and a petition to show the ombudsman how many ladies are having problems.
Maybe then the insurance companies would become more open about what is and is not covered.