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Do’s and Don’ts of Critical Illness Cover Claims

Being diagnosed with a critical illness presents a difficult time for you and your family, but if you have a policy, your critical illness cover can be a solid wall for you to lean on. While your mind will understandably be on other things, money will be one less thing for you to worry about knowing that you can make a claim and receive a payout from your insurer. 

This money may be used for your treatment, or to take care of your family if they previously relied on your income. 

Based on claims reports provided by major insurers, the percentage of critical illness claims paid out ranges from 91% to as high as 98%. One way you can ensure a successful critical illness cover claim is by lodging the claim properly.

To help you with this, below we have put together some simple do’s and don’ts for you to remember when making a claim for critical illness cover.


  • Present the right documentation. It is best that you keep all of your medical records somewhere safe. You will need to present these when you make a claim.
  • Inform your insurance company immediately. As soon as you are diagnosed with a health condition that is covered by your policy, you need to inform your insurance company about it. That way, you can get the ball rolling and the claims process started. This helps to ensure that you get your claim earlier and that you are informed as to what documents you will need to make your claim.
  • Know your deadlines. To ensure a prompt and successful claim, it is best to know very well the deadlines in your policy.
  • Be prepared to appeal. If your claim is denied, you still have the right to make an appeal. Having your claim denied at the first pass is not the end of the road for you. You can work with the insurance claims adjuster to see what additional information is needed to bolster your claim. 


  • Just assume that you are covered. It is important to know exactly what your policy covers. There may be differing definitions of a covered illness, so you need to check under what conditions the illness is payable. Remember that the company will pay only if your claim falls under the definition of the policy. If they don’t, your claim may be denied for not meeting the criteria.

    For instance, some types of cancer are not automatically covered – some cancers that are not critical and may be treated will often not be payable under the critical illness policy. There may also be conditions covering your age, the country where you received the diagnosis and other details.
  • Fill up the application form if you are unsure of the details. If there is a medical detail in the claims form you are not sure about, ask your doctor first before writing anything down. Be sure not to leave any gaps – the insurer may not always contact your doctor to check gaps in your application form.
  • Fail to pay your premiums. Again, this may be late in the game, but failure to pay your premiums after the grace period may mean that your policy is no longer in force. Also keep in mind that you need to continue with the premium payments while your claim is being processed.
  • Make any fraudulent claims. For one, the insurance company will thoroughly check the veracity of your claim. If they find out that you have been making a false claim, they will deny your claim. Also, they may “blacklist” you and this may affect any future applications with other insurance companies. You may also face legal challenges due to your fraudulent claim.

Peak Mortgages & Protection

We hope that this has cleared up any questions you may have had about how to make a successful critical illness claim. If you would like to learn more about critical illness cover, or get some help to find a policy that suits all of your needs, get in touch with Peak Mortgages & Protection. 

At Peak Mortgages and Protection, we love to help people. It’s important to make sure our clients are covered in case the worst happens as well as make sure the people important to you are looked after. When you utilise our services, you can rest assured in the knowledge that you are working with one of the top Protection Brokers in the country, having been nominated for this very category at this year’s British Mortgage Awards.