Critical Illness Insurance – Frequently Asked Questions
- 17/07/2025
- Posted by: Appeal Avenue
- Category: FAQs
What is Critical Illness Insurance?
Critical illness insurance is a type of policy that pays out a one-off, tax-free lump sum if you’re diagnosed with a serious medical condition listed in the policy. This could include illnesses such as cancer, heart attacks, or strokes. Many people use this cover to help pay off a mortgage, cover living costs while they recover, or ease the financial pressure of giving up work.
How is Critical Illness different from Serious Illness cover?
While both types of cover pay out if you’re diagnosed with a serious health condition, serious illness cover usually pays a percentage of the total sum based on how severe your condition is. In contrast, critical illness policies often pay the full amount once your condition meets the severity level outlined in the policy.
What illnesses are covered by Critical Illness Insurance?
Each insurer has their own list of illnesses they cover, which will be detailed in your policy documents. Commonly covered illnesses include some types of cancer, heart attacks, strokes, and conditions like Multiple Sclerosis. However, some illnesses may only be covered if they meet a certain level of seriousness—such as strokes that result in lasting neurological damage or more advanced stages of cancer.
What cancers are covered under Critical Illness Insurance?
Here at Appeal Avenue, we have many years of experience in reviewing declined insurance claims, as a result, we have helped to overturn many claims that have been declined due to non-disclosure misrepresentation. We can look at your policy terms and review how the insurer reached their decision. If we believe the insurance companies decision may be incorrect, we’ll guide you through your options and explain how to challenge it—all for free. If you’d prefer more hands-on support, we also offer a no win, no fee advocacy service where we can act on your behalf—so if we’re not successful, you won’t pay a thing.
Can you help me to appeal my claim even if the insurer says that they wouldn’t have offered me cover if I had told them about my medical condition?
Critical illness insurance typically covers a range of cancers, but the specifics can vary between policies. Generally, insurers cover cancers that are considered life-threatening or have reached a certain stage. Early-stage cancers, pre-cancerous conditions, and some skin cancers may not be included.
For example, prostate cancer is often only covered if it has reached a specific stage—typically T2b N0 M0 or higher. Similarly, common skin cancers like basal cell carcinoma or squamous cell carcinoma may not be covered unless they meet defined criteria.
It’s always best to check your policy documents carefully to see exactly what’s included. If you’re unsure, we can help you make sense of the wording and offer guidance on what your options might be. And if you need more hands-on help—such as challenging a claim decision—we offer a no win, no fee advocacy service where we can act on your behalf. That means if your case isn’t successful, you won’t pay a thing.
Does Critical Illness Insurance include cover for Total Permanent Disability?
Many critical illness policies include cover for what’s known as ‘Total Permanent Disability’ or ‘Loss of Independence’. This usually means you could receive a payout if you become permanently disabled due to illness or injury. Check your policy or speak to us if you’re unsure what your cover includes.
Is there a time limit for making a Critical Illness claim?
Yes—most insurers require you to notify them of your diagnosis within a specific timeframe, often within six months. If you delay your claim due to the emotional impact of your diagnosis or because you didn’t realise you had cover, the insurer may consider this when reviewing your claim. It’s always best to contact them as soon as you can.
Why was my Critical Illness claim turned down?
Insurers usually reject claims because either your condition doesn’t meet the policy’s definition of a ‘critical’ illness, or because they believe there was something important you didn’t disclose when you applied for the policy. If you’re unsure why your claim was declined, book a free appointment with us at Appeal Avenue—we can help you understand the reasons and suggest your next steps, at no cost.
Can I appeal a denied Critical Illness Insurance claim?
Yes. If your claim has been refused and you don’t agree with the decision, you can challenge it. Appeal Avenue can review the insurer’s decision, explain the policy terms, and guide you through the appeals process for free. If you’d like us to take a more active role, we offer a no win, no fee advocacy service where we can handle the appeal on your behalf. You’ll only pay if we’re successful.
When can I take my complaint to the Financial Ombudsman Service?
If you’ve made a complaint to your insurer and are still unhappy with their decision after eight weeks (or sooner if they’ve issued a final response), you can take your case to the Financial Ombudsman Service. They offer a free and independent review of insurance disputes. We can support you throughout this process if you’d like guidance or help making your case.
Can you help me appeal a Critical Illness claim decision?
Absolutely. At Appeal Avenue, we specialise in supporting people who’ve had critical illness claims rejected. We’ll look at your policy terms, your diagnosis, and how the decision was reached. If we believe the decision may be incorrect, we’ll guide you through your options and explain how to challenge it—all for free. If you’d prefer more hands-on support, we also offer a no win, no fee advocacy service where we can act on your behalf—so if we’re not successful, you won’t pay a thing.
What is 'buy back' in Critical Illness Insurance?
If your critical illness policy is combined with life cover, a successful claim usually ends both types of cover. Some policies offer a ‘buy back’ option, which lets you reinstate the life cover (or sometimes even the critical illness cover) after a claim has been paid. If keeping cover after a claim is important to you, check whether your policy includes this option.
Is children’s Critical Illness cover included?
Often, yes. Many critical illness policies offer children’s cover as an additional benefit. This means a lump sum may be paid if your child is diagnosed with a serious illness listed in the policy. The payout is usually smaller than the adult benefit, but it doesn’t normally affect the parent’s cover. Check your documents or contact us for free guidance if you’re unsure.