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How do critical illness claims work?

Find out what to do if you need to claim on your critical illness policy

A photo of Dom Limberg, the author

By Dom Limberg

Published on: 5 February 2023

7 min read

How do critical illness claims work?

Critical illness insurance is specifically designed to pay out a cash lump sum if you’re diagnosed with a serious illness such as cancer, heart attack or multiple sclerosis. The money can be used for many reasons but the main reason is to relieve any financial pressure during a difficult period.  

The reality is that a diagnosis of a serious or critical illness will have a huge impact on your life and so it’s important to relieve any stress where possible. Critical illness insurance is specifically designed to reduce financial pressure and critical illness claims should also be simple. 

Will my critical illness insurance pay out? 

Most of us have been trained to be very cautious when it comes to anything to do with insurance these days. 

The general feeling is that insurance companies will do anything to not pay out on claims, which isn’t always the case. The reality is that critical illness insurance and life insurance have some of the highest pay out rates of any insurance policies. 

You should expect that your critical illness insurance claim would pay out because generally over 90% of claims are paid. The figure for life insurance is even higher, where around 98% of all claims are successful. 

There are usually a couple of reasons why your critical illness insurance claim won’t pay out, such as: 

  • Non-disclosure which is where someone has omitted details from their application, either deliberately or accidentally. This could be a medical condition that you failed to disclose or something to do with your lifestyle. 
  • Condition not covered can happen where someone claims for a critical illness that is not listed on your policy terms. Most of these conditions will either be less severe or something that is quite rare. 
  • If you die due to your critical illness can also happen where someone passes away quite quickly after they are diagnosed (e.g. within 14 days). Often this is where a claim would then be passed to the life insurance part of their policy to continue the claim. 

Find out more about how critical illness insurance policies work.

This would no doubt be an extremely difficult period for you and your loved ones, so it’s important to get things straight before you make your claim. 

All insurance companies will have a dedicated team of people that will help you through the claims process to make sure that you are well looked after no matter the type of cover you have. In most instances, these companies will have many years of experience and expertise in helping people in similar situations so you should be in good hands. 

Here is our step by step guide to making a critical illness insurance claim: 

  1. Find out which insurer you have cover with 
  2. Check your policy documents to make sure that you have a valid claim (if possible) 
  3. Look for the claim department number or critical illness claim form 
  4. Contact the critical illness claims team or complete the forms online 
  5. Speak to your GP or specialist for any medical information 
  6. Provide any additional information that you are asked for e.g. further details about your medical history

Once your claim has been approved your insurer will pay out a tax-free lump sum, with the exact amount received depending on the amount of cover (£s) you have.

Is there a critical illness claim time limit? 

Most insurance companies will allow you a grace period after you are diagnosed with a critical illness to make a claim. 

Some of the most common critical illness claim time limits are between 3 and 12 months depending on your insurance provider. You should ideally notify the insurer as quickly as you can from the point that you are officially diagnosed with the serious illness. 

You might also be able to make a claim after the deadline has passed if you forget that you have critical illness insurance or don’t know what to do. It is unfortunately fairly common for policyholders to forget that they have cover for this sort of situation. 

Legal and General critical illness claim 

The biggest life insurance provider in the UK is Legal and General (L&G) so here is what to do if you have a Legal and General critical illness claim. 

If you have a Legal and General critical illness insurance policy, then you should have all of this information on your policy documents, so it’s worth digging them out first. For anyone who can’t find their policy documents or if you have misplaced them, then here’s what to do. 

Here is our guide to how to make a Legal and General critical illness claim 

When you need to make a claim on your Legal and General critical illness insurance policy there are a number of things you’ll need to know. 

You can contact the Legal and General claims team, Monday to Friday between the hours of 9am and 5pm. The contact number for the Legal and General claims team is 0808 296 3822. 

The same telephone number can also be used for anyone wanting to make a claim for children’s critical illness insurance or for extra cover for ‘Carcinoma in situ of the breast’ or ‘low grade prostate cancer’ definitions. 

Other methods for contacting Legal and General critical illness claims department: 

  • Email: health.claims@landg.com 
  • Post: Legal & General Claims Department, City Park, The Droveway, Hove, BN3 7PY 

When you make a claim to Legal and General for critical illness insurance, you should be able to provide the following information: 

  • Policy number (available on your banks Direct Debit) 
  • Any details that you have about the medical condition or illness 
  • GP or Medical Consultant details 

What happens after you make you claim to Legal & General: 

  • Policy checks to make sure that your critical illness is covered by your policy 
  • Claims team will contact your GP or medical consultant to find out more information about your illness 
  • Claim forms will then be sent to you by email or by post for you to sign and return to the claims team 

You will be assigned a Legal and General claims handler who will be dedicated to your case and will manage the whole process. Your claims handler should continue to keep you updated throughout the your claim. 

Aviva critical illness claims 

The second biggest insurer in the UK for critical illness insurance is Aviva, so here’s a quick section about Aviva critical illness claims. 

You should also be able to find all of this information on your policy documents or on the Aviva website. 

You can contact the Aviva critical illness claims department Monday to Friday between the hours of 8 am and 6pm. The telephone number for the claims team is 0800 015 1142 from the UK (or +44 1603 202 500 if calling from abroad). 

Other ways to make your Aviva critical illness claims: 

What you need to start your claim: 

  • Your contact details 
  • Information about your medical condition 
  • Policy number (can be found on your direct debit) 
  • GP or medical consultant contact details 

Here is some of the main steps and the process for making a critical illness insurance claim with Aviva. 

  • Contact Aviva critical illness claims team either by phone or online 
  • Provide the details that are required to process your claim 
  • Your claims handler will contact you to explain how the process will work 
  • Any successful claims will be paid out to your bank automatically within five working days 

If your critical illness claim is rejected then you have a number of options that are available to you. 

There is usually an appeal process for anyone who feels that their claim is valid. You should contact your insurance provider first of all and tell them why you feel that your claim is justified and the grounds for your appeal. 

If your appeal for your claim is rejected then you can escalate your claim to the Financial Ombudsman Service (FOS). You can also read more about what to do if your critical illness claim is rejected on the FOS website, and there are some case studies to show examples. 

How long does a critical illness claim take? 

Most life insurance providers will work to a similar timescale to process any critical illness insurance claims. This will be for them to gather any evidence and assess the validity of your claim. 

Standard timescales for critical illness claims is between 4 and 6 weeks. 

Best insurance providers for critical illness claims 

One of the biggest questions is which are the best insurance providers for critical illness claims, so how likely are they to pay out. 

Most insurers follow a similar claims process and will pay out similar levels, but there are some insurance providers that pay at higher rates than others. You should be aware of this before you take out your cover and make sure that you are confident that your claim will be paid. 

As we’ve mentioned above, most insurance providers will pay out critical illness claims at rates of around 90% approximately. Below is a table of the main insurers and their pay out rates for critical illness insurance in 2019. 

Insurance provider Percentage of claims paid out for critical illness insurance (2019) 
Aegon 94% 
AIG 96% 
Aviva 93% 
HSBC 98% 
L&G 92% 
LV= 87% 
Royal London 93% 
Scottish Widows 93% 
Vitality 93% 
Zurich 90% 

Note: Each insurer will cover varying numbers and types of critical illness (most commonly types of cancer, stroke, heart attack etc). You may also be able to receive a pay out for total permanent disability if you have added this additional benefit to your cover (usually for an extra cost).

There are lots of variables to how these figures are calculated so you shouldn’t make your ultimate decision based on this alone. If you need more information or advice about where to get the right critical illness insurance, you can speak to an independent insurance advisor. 

Resources

ABI – Payouts for bereavement, illness, and injury claims top £18.6 million a day

ABI – Record amount paid out to help families cope with bereavement, ill health, and injury

Zurich Intermediary – Critical illness data makes astounding reading

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