Question asked by: 
Karin, Warwickshire

I have been diagnosed terminally-ill with stage 4 ovarian cancer. I have critical-illness insurance but so far the insurers have refused to pay out. They insisted on waiting for the result of my treatment. My cancer came back after only a few months and I am now participating in a medical trial.  I plan to contact the insurers again. Can you offer any advice?

I have critical-illness insurance but so far the insurers have refused to pay out. Can you offer advice?
Make sure you differentiate between terminal-illness cover and critical-illness cover.
Response by Simon Ellis and team

I have looked into your Legal & General insurance policy – it is not one that includes critical-illness cover, but is a life policy with terminal-illness cover. It is important to differentiate between these two types of cover as they are quite different. Terminal-illness cover will only pay out if your life expectancy is less than 12 months. If it’s greater than this, they will not pay out. 

I went to the company’s website and here is what they say about terminal-illness cover: 

“Terminal-illness cover is one of the 39 illnesses covered under our critical illness cover. It allows your policy to pay out its proceeds on diagnosis of a terminal illness rather than when you die. By terminal, we mean: 'suffering from an advanced or rapidly progressing incurable illness where, in the opinion of a Medical Officer of Legal & General, your life expectancy is less than 12 months.'

“You'll need to be eligible to claim, so for example, if you've stopped paying your premiums, your policy may not pay out. This cover is not available during the last 18 months of your policy and is not available on plans with a term of two years or less. Once a terminal-illness claim has been accepted, no further claims can be made. No premiums will be payable either and the policy will end.

“If, after a terminal-illness claim has been accepted, you survive to the end of the term; you will not have to pay back the terminal-illness payment received. However, once the payment has been received, the plan will end and no further claims can be made.”

Assuming that the above criteria are met and your life expectancy is confirmed as being less than 12 months, a valid claim should be accepted by Legal & General.

It would be worth checking whether you have any other policies covering critical illness.