Model Definition Of Exclusions In Critical Illness Insurance

The Association of British Insurers had also published model definitions for exclusions in critical illness cover. Some common exclusions found in many critical illness policies are as follows: Aviation, criminal acts, drug abuse, HIV/AIDS, failure to follow medical advice, hazardous sports and pastimes, self inflicted injury, living abroad and war and civil commotion. Let’s have a look at the definitions for the above exclusions in critical illness cover.

Taking part in any flying activity, other than as a passenger in a commercially licensed aircraft.

Criminal acts
Taking part in a criminal act.

Drug abuse
Alcohol or solvent abuse, or the taking of drugs except under the direction of a registered medical practitioner.

Failure to follow medical advice
Unreasonable failure to seek or follow medical advice.

Hazardous sports and pastimes
Taking part in (or practising for) boxing, caving, climbing, horse-racing, jet skiing, martial arts, mountaineering, off-piste skiing, pot-holing, power-boat racing, under-water diving, yacht racing or any race, trial or timed motor sport.

Infection with Human Immunodeficiency Virus (HIV) or conditions due to any Acquired Immune Deficiency Syndrome (AIDS).

Living abroad
Living outside of the European Union for more than 13 consecutive weeks in any 12 months.

Self-inflicted injury
Intentional self-inflicted injury.

War and civil commotion
War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution or taking part in a riot or civil commotion.

When you are on the verge of taking out a critical illness cover, check out for these exclusions in your policy documents. Anything you miss to read from your critical illness policy may affect your lump sum. If you are suffering from HIV/AIDS for example, you may not be able to get a critical illness cover. Some insurance companies might accept you as a critical illness policy holder but you could be more likely to pay high premium amounts. Less insurance companies might accept to give cover to people who have formed part in any one of these exclusions.

While exclusion can stop you from having a payout, non disclosure of certain factors about your present health or health history can also do so. As per, Critical illness News update, May 2007, a total of around 1566 critical illness claims could have been reviewed. Out of this, 80 percent of claims, that is, about1257 critical illness claims could have been paid. More precisely, approximately 309 claims therefore remained unpaid. Of this, nearly 9 percent could have been rejected due to not meeting policy definitions while about 11 percent could have been declined due to non disclosure.

Non disclosure means not revealing about certain aspects concerning your health. Before you take out critical illness cover, your insurers would ask you questions. These questions could be concerning these exclusions listed above or even if members of your family had suffered from any common disease. If your answer did not comply with the critical illness insurance company standards, you could be made to undergo medical tests. It is only after having a close look at the results that your insurers would decide to give you cover or not. Many insurance companies carry out this procedure because inherited critical illness may affect every member of a family.

Every person that takes out critical illness cover may have in mind that the payout is obtained hassle free one day. It could be devastating to know that your critical illness claim has been rejected after so many years of contribution. The worse thing is that many insurance companies may not refund this hard earned money. As a precaution to avoid such dilemmas to crop in the future, the bottom line remains that you should read may be everything from start to finish in your critical illness policy.