Make a new total permanent disability claim
Many people take out Critical Illness insurance to run alongside their mortgage, or to protect them if they need to give up work following a serious illness. Critical illness insurance policies may be ‘standalone’- where they just cover the insured person in the event of contracting a serious illness, and others may be combined with a life assurance policy.
Critical illness insurance is designed to pay out a one off, tax free lump sum in the event that the insured person is diagnosed with one of the illnesses specified in the policy terms and conditions. The illnesses covered by critical illness policies generally includes heart attacks, strokes, Multiple Sclerosis and cancer. Most critical illness policies also cover something called ‘Total Permanent Disability’ or ‘Loss of Independence’, which offers a payout if you become ‘disabled’ due to an illness or injury.
It’s important to know that total permanent disability and loss of independence insurance is not based on your condition or diagnosis, but is instead based on how that condition or illness impacts you. Everyone’s experiences are different and how their illness or disability impacts them can vary considerably.
Insurers tend to have different rules as to what they define as ‘total permanent disability’ or ‘loss of independence’, but generally it falls into two categories. The first being your ability to continue working and the second being your ability to carry out activities of daily living or household tasks.
Occupational based total permanent disability
With this type of cover, your critical illness insurer is looking at your ability to continue working with your illness. This may be based on your ‘own’ or ‘any’ occupation.
For ‘own’ occupation policies, your insurer will look at the job you were doing when you took out your policy, or immediately before your illness started. They will then look at whether or not your illness prevents you from continuing to perform that job, or that ‘type’ of job now and in the future. The inability to do that job would also need to be ‘permanent’ for a claim to be paid.
If your insurance policy is an ‘any’ occupation policy, the insurer will look at how your illness impacts you and whether it would prevent you from carrying out any form of work, now and in the future. The inability to do that job would also need to be ‘permanent’ for a claim to be paid.
Activities of daily living/household tasks based total permanent disability.
If your total permanent disability insurance is based on activities of daily living or household tasks, your insurance policy terms and conditions will usually list a number of tasks such as dressing and undressing, walking up and down the stairs, maintaining personal hygiene and household tasks like cleaning, cooking and shopping.
They will then usually state that you would need to be incapable of carrying out a specified number of those tasks to qualify for a claim under their total permanent disability clause. The inability to carry out those tasks would also need to be ‘permanent’ for a claim to be paid.
Your critical illness policy terms and conditions will tell you what your insurer defines as a total permanent disability.
How do I make a claim for Total Permanent Disability or Loss of Independence cover?
Let Appeal Avenue handle the claim process for you
Our team understands the impact a disability can have on every aspect of your life, from work and finance to relationships and wellbeing. You may be struggling to come to terms with a loss of independence, wondering how you will manage financially or considering how to adapt your home to suit your ongoing needs.
Whatever your diagnosis, Appeal Avenue can handle every aspect of your total permanent disability claim for you. We can advocate on your behalf, complete every claim form and ensure you are kept updated at a time and in a way that suits you.
We will take away the hassle and burden of completing claim forms, ensuring that we clearly represent how your health condition impacts you.
If you need a helping, friendly hand, this is something we can help you with- make an appointment with us today for us to support you through it.
Or, make your own total permanent disability claim following our guide below
1. Make a total permanent disability/ loss of independence claim as soon as possible.
Most insurers specify that you must make a claim within certain timeframes, so it’s important to contact them and get the ball rolling as soon as possible.
2. Contact your insurance company.
To make it easier to make a claim, insurers often allow you to start your claim by email, over the phone, by post or even online.
3. Provide some basic information.
When you first contact your insurer, be prepared to provide some basic information about your condition, such as the illness you have been diagnosed with and the date you were diagnosed.
4. Complete a total permanent disability claim form.
After your initial contact, the insurer will usually send you a total permanent disability claim form to complete and return. This form will ask for more information about your condition, such as when you first started experiencing symptoms of your illness, what tests and investigations you’ve had and the names and addresses of your GP and hospital specialists.
5. Provide detailed and specific information.
The total permanent disability claim form will ask you about your condition and how it impacts you. It’s important to be detailed and specific:
For example, if your insurance policy is based on activities of daily living, and talks about getting dressed and undressed, explain what this activity is like for you- can you take off, and put back on, ALL items of clothing including socks, bras, tops and specialist clothing to support your illness? Is it painful? Is it possible? Do you need someone to help you? Do you need aids to support you? How long does it take? What can you do and what can’t you do? It’s important to detail this for every activity named under your policy terms.
If your insurance policy is occupational based, think about your job and how your condition prevents you from carrying it out. Think through what a typical day would look like in your job and how your illness would prevent you from doing it (you might find getting a copy of your job description and duties helpful with this).
It can be tough completing these claim forms and making sure you detail your illness and how it impacts you as clearly as possible- if you need a helping, friendly hand, this is something we can help you with- make an appointment with us today for us to support you through it.
6. Wait
This can be the most frustrating part of the process- the time between you submitting your total permanent disability claim and hearing back from the insurer can take a number of weeks.
In this time, the insurer will be writing out to your doctors and getting more information about your condition and how it impacts you. This may include requesting a copy of your recent medical records. They might also be looking into the answers you gave to the health and lifestyle questions you were asked when you initially took out your insurance policy.
7. Decision made by the insurer.
When the insurer has all of the information back from your doctors and they’ve reviewed it against your policy terms and conditions, they will make a decision on whether or not to pay your claim.
If the claim is successful, they will contact you and let you know when to expect your payment.
If the insurer declines your total permanent disability claim, they should tell you why they have declined it. If your total permanent disability claim is declined, you can make an appointment with us to talk through what your options might be. If we think you have grounds to appeal the insurers decision, we may be able to complain on your behalf- take a look at the fees section of our website for an idea of the costs involved.
Ready to start your permanent disability claim?
Start a new claim or get help with your declined permanent disability claim today.