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Old 07-06-2005, 03:53 AM   #1
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critical illness

Does anyone have any experience with critical illness insurance ? following two CA stents my insurance company should pay out for this critical illness. I wondered if anyone had any experience of them using obesity as a 'get out' cause to avoid payment. my doctor and cardiologist differ as to whether they should consider obesity as simply one of the 'risk factors' (and a minor one at that compared to cholesterol/smoking etc) or if its causative, enough for the insurance company to wriggle out of it.

Perhaps a strange question for the forum :-)

 
Old 07-06-2005, 08:37 AM   #2
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Re: critical illness

The insurance coverage is applicable unless there is a rider with the policy that specifies the exceptions.

There maybe a denial to issue a policy based on some risk factors, but those disqualifying factors should/would have been disclosed with the insured's application. Acceptance indicates approval to the terms of the contract. If obesity was not a medical issue considered by the insurer prior to a condition, it can't decide later to make it an exception; however, with a renewal and acceptance by the insured there can and often are policy changes.

 
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Old 07-08-2005, 12:39 PM   #3
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Re: critical illness

thanks for that. Unfortunately they state that "if, in the view of their medical advisor, there was a preexisting condition which indirectly or directly led to the diagnosed condition" then they won't pay out. I guess I'll find out eventualy.

thanks again

 
Old 07-09-2005, 08:35 AM   #4
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Re: critical illness

A heart problem maybe the pre-existing condition the insurer will not accept as a liability. But to allege one of the risk factors caused the condition and on that assumption avoid responsibility seems a stretch; but I'm not familair with "critical illness insurance" !

And to rely on the insurer's medical examiner for an opinion and solution is troubling as the medical examiner's job is to save the insurer money.

 
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