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.
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.
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.
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.