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Peter Chadborn: Stats are the best ammunition in the fight for protection


Non-paid claims of critical illness polices have kicked off another debate in recent weeks. It started with a worrying piece in the Mail on Sunday, with the headline: Thousands for a broken elbow, nothing for a lethal tumour. Is the system fair?

Headlines like this should make anyone working in the protection industry wince. We can criticise consumer press articles but to do so misses the point.

It is also worth remembering the paper in question runs many positive protection stories but, of course, it is the negative ones people remember.

Indeed, the public’s perception of the industry beats reality. Surveys show people believe successful claims are at around 50 per cent at best. This is why producing claims statistics for all types of protection insurance is so important.

Of course we cannot just pay all claims, but being seen to win an argument on a technicality is part of the problem. Those of us who advise, manufacture, underwrite and pay claims are expected to know the detail.

Our clients are laypeople that are never going to read the voluminous guide of CI definitions.

They enter into a contract with the motivation generally along the lines of: “If I get really ill – you know, cancer and all that – then I’ve got a financial cushion to help me out, so I guess that’s worth paying for.” The policy is acquired, often reluctantly, and will be buried in a filing cabinet hoping it is never needed.

Several years later and there is bad news from the doctor. The C-word. Scared, they try and rationalise. “Will I be ok? Wait, there is a silver lining of sorts. At least I had the foresight to buy that critical illness insurance policy thanks to that adviser that convinced me it was important. What a relief!”

But the claim goes in only to be told that, technically, while they do have cancer, it does not quite meet the definitions of the contract.

You can argue the cover was not positioned properly by the adviser but I am generalising to make a point.

The level of technical knowledge required to understand what does and does not constitute a valid claim for every definition on every different insurer’s CI policy is beyond the ability of most advisers, let alone consumers.

We know non-paid claims are in the minority. We know insurance policies cannot cover everything or they would be unaffordable. But we also know negative stories make for scary headlines and so the importance of claims statistics and the imperative message of the continued decline of non-paid CI claims is a powerful counter to negative consumer perceptions.

I understand the percentage of CI claims being paid continues to rise, with 93.1 per cent paid last year (up from 80 per cent in 2005). As an adviser at the front line, I can tell you trying to defend the story of a declined claim on a technicality is impossible.

However, there is a fighting chance of convincing a skeptical client the protection industry is onethat does try to do the right thing when we are armed with statistics such as this.

Peter Chadborn is director and adviser at Plan Money



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There is one comment at the moment, we would love to hear your opinion too.

  1. Here we go again. Peter if it was that easy don’t you think insurers would do it? How do you price this? Who decides whose claim is deserving or critical and whose isn’t? Do you really think that insurers sit in their ivory towers heartlessly turning down claims?

    The insurance claims process will never be perfect for any product because some claims will always be turned down because people dont tell the truth or the scope of the cover does not extend to the misfortune they have suffered. The journo’s will live of these whatever insurers do.

    Critical Illness is one of the least perfect products because despite its name it does not cover all critical illnesses (critical being a very subjective) term. So tell me what you want to do with it Peter? Withdraw the product and take away valuable cover for our clients? Or change its name to “Insurance that only covers the conditions specified in the policy conditions”? That really slips off the tongue well and doesnt it say just that prominently in the KFDs and PCs any way.

    Yes the product is very complex and is getting more complex. As an IFA if you dont understand or cant explain a product adequately to a client should you be selling it?

    As for that journalist? He might be your friend but is he really a friend of the industry? His job is to write stories and make headlines, so he does whether they are correct, fair or otherwise. Read the headlines he used “Exposing the baffling world of insurers”, “More than 3,000 people have a claim rejected on a financial protection policy every year”, “he Mail on Sunday probes into the murky world of protection insurance…” Is that a friend to the industry? He then goes on to compare IP with CI cover – two totally different contracts, without any explanation. What next PMI versus Life – man gets paid for having grommets in his ears but doesnt get paid for Terminal Illness. In my opinion he is a parasite – like other symbiotic parasites he can do good but he can also do harm, and this article fell in to the latter category…

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