Policy definition not met: For Critical Illness insurance, if you suffer from an illness or injury, you will only be entitled to claim under a policy if the type and severity of the condition meets the definition in that policy. For example, low grade skin cancers are not likely to result in eligibility to receive a benefit under a Critical Illness/Trauma policy. This is because the policy is designed to cover serious events that result in a financial impact to you.
Qualifying period: For Critical Illness insurance, it’s common to be required to hold a policy for a specified period (also called qualifying period) before the cover starts in full. If, for example, a qualifying period applies before cover starts for certain medical conditions, then a claim would not be payable if symptoms of the condition first occurred before or during the qualifying period; or if a diagnosis was made before or during the qualifying period.
Waiting period: For Income Protection, typically a waiting period will apply. Generally this means that you need to be unable to work for a specified period of time after an illness or injury before you’re entitled to a benefit under the policy. For example, if a waiting period of 3 months applies, then no benefit would start to accrue or be paid until the end of the 3 month period and will likely not be payable until a further month has passed.
Benefit period: For Income Protection, there will be a limitation on the maximum amount of time a benefit can be paid for. This is the length of time for which you may receive a benefit under the cover, if your claim is accepted. For example, if the benefit period under your Income Protection cover is 2 years, then once a benefit has been paid for 2 years, the benefit would cease, however you may be able to claim again if you suffer from another, unrelated condition in future. Typically benefits are only payable up to a particular age (e.g. 65), irrespective of how long the benefit period is.
Multiple claims: Some cover types only allow one claim under the cover for a certain illness, injury or event. In those circumstances, if you’ve already made a claim, your cover may end, or you may not be entitled to another benefit for the same condition.