Life and disability insurance
Common issues people have about life and disability insurance are: forgetting to tell their insurer information, the conditions for payment under the policy, the information they have to provide when making a claim, and when an insurer is entitled to refuse to pay, See our information below, or for further help contact us.
Info sheets are quick guides to common problems.
Do I have to tell my insurer everything about my medical history?
Yes. This is important information which helps your insurer assess your application and can affect the terms of cover it will offer you. If you do not give your insurer the information it may avoid your policy and decline to consider a claim.
Many people do not understand what sort of medical information the company needs to know when assessing an application for life, disability or health insurance. If you are unsure or cannot remember your full medical history, check with your doctor, or provide a full copy of your medical history with your application.
What if I just forgot or left out information unintentionally?
The current law does not make a distinction between innocent or deliberate non-disclosure. If you accidentally leave out information on the application, your insurer can still avoid your policy if you make a claim.
Why has my insurer only raised this issue about lack of information now, when I have made a claim?
When you make a claim, your insurer will ask you more questions or check up on your history. This can lead to your insurer finding out information which it should have been given when you applied for insurance.
Why is it that my doctor says I can't work but the company won't pay me?
Your insurer will only pay you if you meet the definition for "disability" in your policy. This definition is different for each policy. For example: your policy may cover you if you cannot do your job any more, or it may only cover you if you can never work in any job ever again.
This question is different to the question about whether you have a medical condition or problem. You may not able to work, but still not meet the definition for "disability" in your policy. See the info sheet: Disability Insurance.
How much information can my insurer ask me to give when I make a claim?
You must give your insurer enough information to prove you have a valid claim. However, your insurer is entitled to obtain further information, which may include specialist medical reports or further financial information. This can be an ongoing process, as your insurer may need information from a number of people, and they may ask you to see a doctor or specialist it appoints.
How long can my insurer take to accept my claim?
It is difficult to put a time limit on how long it takes to assess a claim. Often your insurer will need more information from medical specialists, and this can take a number of months. Your insurer is entitled to fully assess the claim and can request this information, even if you do not think it is necessary.
Why won't my insurer cover the full costs of my surgery?
Your insurer only has to meet its obligations under the policy. Unless your policy says the company will meet all your costs, it does not have to do so. Often the company will cover a proportion of the costs, or will pay standard costs for a procedure.
What is a pre-existing condition?
This will be defined in the policy. There are a number of different definitions for pre-existing conditions. Some policies may define them as any medical condition traceable to a condition you had before taking out the policy, even if you did not know you had it; others will define them as conditions you knew you had before taking out your insurance. However, exactly what is a pre-existing condition will depend on the particular policy.
It is also worth remembering that if you suffer an injury or sickness, or develop a condition while you have insurance cover and you subsequently change to a new insurer, it is likely this will be treated as a pre-existing condition and no cover will be provided for it. See the info sheet: pre-existing conditions.
Search the case studies of complaints to the IFSO Scheme.