Understanding Critical Illness Insurance

Understanding Critical Illness Insurance

Appendix A Medical Exams and Claims – READ THIS PART FOR SURE

The reason medical exams are so important is because if your claim gets denied after your claim, it’ll probably be due to something on your medical exam. Therefore we need to know how a life company can deny a claim using your medical exam, and how to guard against this.

First however, lets dismiss some misunderstandings around insurance medical exams. Medical exams don’t involve running on treadmills or any sort of anal probing. Depending on the policy type, an insurance medical exam will consist of some combination of these three things:

  1. A short yes/no questionnaire.
  2. A medical history report (generally 20-30 fairly in depth questions).
  3. A blood and urine test, conducted in your home by a paramedical.

, or from confusing a no medical questionnaire with a medical history questionnaire.

Now lets get into why this is so important, and how it relates to claims.

There are one very important reason why a life insurance company can deny a claim. The reason is clearly stated in the policy, I’ll paraphrase it here:

Failure to disclose & fraud – The insurance company can (and will) deny your claim if there’s misinformation or lacking information in your application which includes any medical exam or questionnaire.

Now this is where we get to the guts of it. People often think that as long as they didn’t lie on the application that’s fine. It’s not. Your medical questionnaire must be complete, detailed, and verbose. AND you must answer the questions they asked, not the questions you think they asked. I know that sounds rhetorical. It’s not – people do this all the time.

When you do your medical questionnaire Stop. Listen to each questions carefully and slowly. Answer all questions fully, completely and verbosely. Leave nothing out, from your entire life. No detail is too small. If you’re not sure it’s relevant, disclose it anyway.

Let’s do an example. Here’s your first medical question. Imagine I’m reading it fairly quickly:

Have you ever had any tests, investigations, injury, treatment, or surgery on your eyes?

And most people say ‘no, my eyes are fine’. Which is to my earlier point – the question was not ‘are your eyes fine’. The question was…

Have you ever had any

  • tests,
  • investigations,
  • injury,
  • treatment, or
  • surgery on your eyes?

That’s five questions, none of which just got answered.

I’ve had people with eyeglasses look at me and answer that question no. So, you’ve never had surgery, OK. You’ve never had treatment. OK. No injury, ever. OK. No investigations either. Also OK. But tests? Sure you have. Most people have their eyes tested every two years. So at a minimum you should answer this question something like this:

I get my eyes tested every two years, and I have to take no corrective action and have no issues.

You may wonder why this matters. Ultimately you just need to know that it does matter – ‘why’ is tough to answer because it varies. But let me make up an example. Insurance companies may want you to have your eyes tested routinely because diabetes symptoms can show up in eye exams – and insurance companies do care about diabetes. So, tell them. Details matter and neither you nor I will know what details matter – so disclose them all.

Being detailed and verbose on your medical history questionnaire is the single biggest thing you can do in order to ensure your life insurance claim is paid without delay and without denial. It will also make the application process quicker and will often (counter intuitively) increase your probability of getting cheaper premiums.

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