Hi ,

You may have seen the recent news about a policyholder disputing a critical illness claim after suffering a brain aneurysm.

I thought it was worth sharing because it highlights something important:

When it comes to critical illness coverage, it is not enough to know that a condition is listed in the policy.

The actual payout depends on how that condition is defined.

This issue arose as Prudential's policy definition for brain aneurysm surgery stated that the condition must involve surgical craniotomy, meaning open-skull surgery. It also excluded endovascular repair or procedures.

By comparison, another insurer’s definition has a separate section that recognises brain aneurysm surgery via endovascular procedures, subject to the exact policy terms and claim assessment.

This difference may look technical, but it can matter greatly at the claim stage.

Two policies may both appear to cover “brain aneurysm”, but the actual payout outcome can differ depending on the treatment method, severity, and how the condition is defined in the contract.

This is also why working with a multi-provider adviser can be valuable.

Different insurers may define the same condition differently. Some may have broader wording in selected areas, while others may be more restrictive depending on the condition, stage, or treatment method.

Because we have access to multiple insurers, we are not limited to one company’s product range. This allows us to compare across providers and recommend a plan based on your needs, budget, health profile, and the quality of the coverage wording, not just the premium or sum assured.

That said, definitions will still differ from insurer to insurer. No policy covers every situation, and every claim is still assessed based on the exact contract wording and medical evidence.

So it is always good to review your existing coverage from time to time, especially if your policy was bought many years ago.

A review can help you understand:

Whether your current critical illness coverage is still relevant

How strict or broad the definitions are.

Whether newer plans may offer broader wording in selected areas

Whether your coverage amount is still enough today

This is not about buying more insurance for the sake of it.

It is about knowing what you are actually relying on before a claim happens.

If you would like me to help you review your critical illness coverage, feel free to reply to this email or WhatsApp me.

Warm regards,

Zest

Executive Wealth Consultant | Associate Estate Planning Practitioner |

Licensed General Insurance Advisory

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