A range of insurance products cover the risk of death (life insurance), specified life-threatening health conditions (trauma insurance), or the inability to work (income protection or disability insurance). This cover can be essential if you have financial commitments. Take time to decide whether the cover is right for you.
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Check out the Financial Services Council (FSC) FSC Code of Conduct* that has the nine standards which fall into three core objectives covering: principle ethical standards, consumer information and communication, and delivering good outcomes to consumers. (*This is a industry code for FSC Members only (mainly made up of Life & Health Insurers, Investment Funds), and is designed to support the professionalism of the financial services industry and the FSC members. It is about increasing trust and confidence in the providers of financial services and the products they deliver.)
Get a copy of your policy and ask questions about the cover to ensure it is right for you. Trauma insurance, for example, doesn’t cover traumatic events. It will only cover certain specified life-threatening health conditions as set out in the policy e.g. only defined cancers and heart attacks.
Declined claims due to exclusions are a common complaint to the IFSO Scheme. A life insurance exclusion could be death caused by dangerous or illegal activities. An income protection limitation could be the cover only applying for a limited time period.
Give your insurer full details of your medical history. Don’t guess. Even if you accidentally leave out details, your future claim could be declined, and your policy treated as though it didn’t exist. Your insurer will not usually get a copy of your medical notes. It’s a good idea to get your own copy of your medical notes to either give to the insurer or to refer to when filling out the insurance application forms.
It is important for you to know the ongoing cost of your life, trauma or income protection insurance. Some policies have a fixed cost, while others will increase as you get older (stepped premiums). Ask questions about the future costs of the insurance to avoid surprises.
If you change your life, trauma or income replacement insurance, the new insurer will take into account your full medical history up to that date. This may mean you are not covered for medical conditions your current policy would cover, exclusions could be added to your new policy, or you could pay more in premiums. It is important to understand the risks of changing cover, particularly if you have had any changes to your health.
Yes. This information helps your insurer assess your application and can affect the cover it will offer you. If you do not give your insurer the information, it can decline to consider a claim and treat your policy as though it did not exist. If you are unsure or cannot remember your full medical history, it can be helpful to get a copy of your medical records to refer to when completing your insurance application, or to give a copy to the insurer.
The current law does not make a distinction between intentional and unintentional non-disclosure. If you accidentally leave out information on the application, the insurer can still treat the policy as if it didn’t exist and decline to consider a claim.
When you make a claim, your insurer will check your medical history. This can lead to your insurer finding out information which it should have been given when you applied for insurance. The insurer can then take the action it would have if it had known about the information.
Your insurer will only pay you if you meet the definition of total or partial disability in your policy. This definition is different for each policy. For example: your policy may cover you if you cannot do your job anymore, 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 are very unwell. You may not feel able to work, but still not meet the definition for "disability" in your policy.
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. You may also have to see a doctor regularly to fill in updates for the insurer and have to pay for them.
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.
Most life and health insurers are members of the Financial Services Council (FSC) and sign up to the FSC Code of Conduct* that has the nine standards which fall into three core objectives covering: principle ethical standards, consumer information and communication, and delivering good outcomes to consumers.
(*This is a industry code for FSC Members only (mainly made up of Life & Health Insurers, Investment Funds), and is designed to support the professionalism of the financial services industry and the FSC members. It is about increasing trust and confidence in the providers of financial services and the products they deliver.)