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Claiming on your Critical Illness policy after a hear attack can be confusing. There are different types of definitions of heart attack that can be detailed within your insurance policy and often it can be difficult to understand the thresholds involved to make a successful claim.
The current ABI guidelines (impacting policies sold after September 2022) define a heart attack as :
“A definite diagnosis of acute myocardial infarction with death of heart muscle as
evidenced by all of the following:
- Typical clinical symptoms (for example, characteristic chest pain).
- New characteristic electrocardiographic changes or new diagnostic imaging
changes.
- The characteristic rise of cardiac enzymes or Troponins recorded at the following
levels or higher:
– Troponin T > 200 ng/L (0.2 ng/ml or 0.2 ug/L)
– Troponin I > 500 ng/L (0.5 ng/ml or 0.5 ug/L)
The evidence must show a definite acute myocardial infarction.”
These thresholds are similar to previous definitions the ABI has set out.
Many of the people we see applying for a “critical illness heart attack payout” have their claim rejected for the following reasons:
- There has been no changes in their ECG (known as an nSTEMI heart attack)
- The troponin levels have not reached the required threshold
- There has not been a combination of the above
The three main types of MI (Heat Attack) we come across are, STEMI (More serious types), nSTEMI (Can be less serious than a STEMI) and unstable Angina.
The most rejections we see from insurance companies are in the nSTEMI category. This is because there is normally no changes seen in an ECG (nSTEMI stands for non-elevated ST wave myocardial infarction) as the ST wave does not change.
Some insurance companies will also suggest that the Troponin levels have not been breached (Troponin is a protein found in the blood which in an indicator of heart muscle damage), therefore will not pay.
Resolute Claims have helped several customers who have had critical illness claims rejected . For one customer they had a MI in the morning but didn’t go to hospital until over 12 hours later. At that point his Troponin levels were measured and were below the cut off point. Our medical experts were able to prove that his Troponin levels would have breached the thresholds if taken shortly after his symptoms.
Some customers may have had what they considered a “small” MI and never claimed on their policy. Many people ask what the critical illness claim time limit is.
Normally policies will stipulate you need to claim within three months to six months of your diagnosis, but in reality we have made claims over 13 years after the event. It can be tricker to get accurate medical information but often your medical records will still hold details of tests and results that were done.
If your critical illness claim has been rejected, get free expert guidance from Resolute Claims.
