Life and Critical Illness insurance offers financial protection for life-changing instances.However, insurance companies can often breach insurance policies, leaving individuals or loved ones without coverage.
Insurance companies prioritize protecting policyholders and generating revenue, often using tactics like contract technicalities.
If a claim is denied due to invalid or unfair reasons, you may be entitled to make a claim against the insurer. This article provides information on breach of insurance and how to make a claim with a solicitor.
What is Life and Critical Illness Insurance?
Life insurance and critical illness insurance are different types of insurance but serve a similar purpose.
Life insurance provides financial protection for loved ones if you die within the policy term, while critical illness insurance focuses on helping you live after being diagnosed with a serious illness. The insurance company provides a lump sum to help with your finances if the health condition is covered.
A ‘breach of insurance’ occurs when insurance companies wrongly refuse to pay out, despite paying premiums and adhering to policy provisions.
What is a breach of insurance?
Insurance companies are responsible for protecting policyholders and making money, often using tactics to deceive non-lawyer customers into believing they are not entitled to a payout.
This can lead to a breach of the insurer’s contract, as it may not accurately reflect the technicalities of the contract and may not accurately reflect the true nature of the situation.
Insurance holders have protections to ensure they receive their payouts, and with the help of a knowledgeable solicitor, claims can be made against the insurance company if they believe they should be entitled to a payout.
Steps to make a breach of insurance claim.
If you believe that an insurance company has breached its obligations under your insurance policy, you will need to take certain steps to make a breach of insurance claim.
Here is a general guide on what you can do:
1. Review your policy:
Carefully review your insurance policy to understand the terms, conditions, and coverage details. This will help you determine whether the insurer has indeed breached the contract.
2. Document the breach:
Collect evidence that supports your claim of breach. This may include letters, emails, policy documents, claim denials, or any other relevant communication. Document specific instances where you believe the insurer has failed to fulfil its obligations.
3. Contact your insurance company:
Initiate contact with your insurance company to discuss your concerns. Explain why you believe there has been a breach of contract and provide the supporting documentation.
It is important to keep a record of all communications, including dates, times, and names of the individuals you speak with.
4. Request a Written Explanation:
If the insurer’s response is not satisfactory, consider requesting a written explanation for their actions or decisions. This documentation can be useful if you need to escalate the matter.
5. Follow Internal Complaint Procedures:
Insurance companies have internal procedures for handling customer complaints.
Follow these procedures, which may involve submitting a formal complaint in writing to a specific department or individual within the insurance company.
6. Seek Legal Advice:
If your efforts to resolve the issue directly with the insurance company are unsuccessful, consider seeking legal advice.
A legal expert with expertise in insurance law can assess the situation, provide guidance on your rights, and help you determine the best course of action.
Reasons that your insurance can be invalidated.
Although in some cases insurance companies wrongly breach their contract, you need adhere to the policy provisions to ensure it is valid.
We have rounded up seven reasons why your insurance company may legitimately refuse to pay out:
Non-disclosure: i.e. saying you do not smoke, or you have no existing medical conditions during your insurance application could void the policy when you die.
Non-payment: If your policy has lapsed due to non-payment, it is crucial to set up automatic payments and update the payment method to avoid insurer refusal.
Cause of death excluded by the policy: Insurance policies may exclude certain causes of death, such as high-risk activities or criminal activities, depending on the policy provisions.
The beneficiary died before the insured: To avoid complications in claiming life insurance benefits if one beneficiary dies before you, consider naming a secondary or even a third beneficiary to simplify the process.
Waiting period: Certain insurance policies may have a waiting period, such as the first 12 months, where certain causes of death may not be covered, and the beneficiary may not receive a payout.
Suicide: Life insurance policies may or may not cover suicides, depending on the policy provisions, and may only cover suicide after a set number of months.
Term expiry: Certain life insurance policies have a set term, and if the policyholder does not die during the term and does not purchase another policy with another provider, their death will not result in a payout.
Frequently asked questions:
What are the different types of life insurance?
There are several types of life insurance policies which will benefit give you distinct types of cover, to benefit you depending on your personal circumstances.
Each contract will specify different provisions, but if your insurer has broken these provisions, it may be a breach of contract.
Whole-of-life insurance guarantees a lump sum payout for loved ones regardless of death, unlike term life insurance which only guarantees a payout within the specified term of the policy.
- Critical illness insurance:
Critical illness cover provides a lump sum payment for life-threatening conditions like heart attack, stroke, and cancer, often included in life insurance policies, typically covering life-threatening conditions.
An over-50’s life insurance plan is a guaranteed policy for individuals aged 50-80, providing easy coverage without medical checks. It lasts the rest of your life if you pay your monthly premiums. If you are over 50, you can choose a regular life insurance policy to suit your needs.
Term insurance provides life coverage over a predetermined period, paying out a lump sum if the insured dies, offering financial security for dependents.
Group life cover is a type of life insurance that covers a group of employees of a company, with the employer owning the policy and paying premiums. It is term insurance, only paying out if the employee dies while working.
How much does life insurance cost?
Life Insurance premiums vary depending on multiple factors such as your age, health, occupation, and smoking status. To find the best life insurance for you, use an online comparison website such as MoneySuperMarket.com.
When should I make a claim?
A breach of an insurance contract occurs when one party fails to fulfil its contractual obligations as outlined in the insurance policy.
Insurance contracts are legal agreements that specify the terms, conditions, and obligations of both parties. If your insurer fails to meet these obligations, it may be considered a breach of the insurance contract, and you may be able to make a claim.
Further information:
Life and Critical Illness Insurance Claims.
WHAT TO DO NEXT:
From the start of your claim until the conclusion you will have a dedicated advisor who will run your claim, assisting you in the event of any queries or issues you may have.
Regular updates will be provided by your case handler up until your claim has ended. This is to ensure the process is as stress-free and effortless as possible.
Get in touch today for a no-obligation consultation. Choose one of the methods on the right-hand side of this page or call us on 0113 200 9720 to find out how we can help you.
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Aidan Khan joined Oakwood Solicitors in January 2025 as a Paralegal working in the Financial Litigation department. Aidan specialises in banking scam claims, having focused on this area prior to joini…
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