How to claim on critical illness cover

A critical illness claim depends on evidence that matches your policy's wording. Start with the claims team, then ask which report is needed, who has been asked for it and what remains unresolved. That makes a delay easier to understand without promising a payment date.

Updated 11 November 20267 min read

At a glance

  • Contact the insurer's claims team to start the process.
  • Use the wording that applies to your own policy.
  • Ask which medical reports and permissions are outstanding.
  • A claim deadline and a complaint deadline are different things.

How to start a critical illness claim

Contact the insurer's claims team using the details in your policy documents or its current official website. Insurers commonly accept an initial notification online or by phone. The team can explain the forms and evidence needed for that policy.

You do not have to work out the final claim decision yourself before getting in touch. If you are unsure whether a diagnosis could qualify, describe what has happened and ask which benefits the team can assess. A missing policy number need not stop an initial enquiry because insurers can often trace cover using other details.

Have the following available if you can.

  • Your name, contact details and policy number.
  • The diagnosis and relevant dates as recorded in your medical letters.
  • Your GP's details and the hospital consultant's name and department.
  • Copies of letters or discharge information already given to you.

Ask for a claim reference and the next step. If you need help handling paperwork, ask how to authorise somebody to assist you. Keep a copy of what you send and a short record of conversations.

Cover through work may use forms completed by both employer and employee. Our guide to group critical illness cover explains that separate arrangement.

Find the wording that belongs to your policy

A policy definition is the written test a condition must meet for payment. An exclusion is something the policy leaves out. The claims team needs to assess the medical evidence against your particular definition, any exclusions and the rest of your contract.

Ask for the policy wording and schedule if you cannot find them. The schedule is the document recording your individual cover and any special terms. A current sales page may describe different cover from the policy you bought years ago.

The Association of British Insurers, known as the ABI, publishes minimum wording standards. In November 2026, it lists its September 2022 guide, updated in April 2023, as the current version. The standards help you understand the wording, but your claim depends on the contract that applies to your cover.

Some policies also have a survival period. This is the stated time the insured person must live after the relevant event before a benefit can become payable. It is a policy condition, rather than a promise about how quickly an insurer completes its checks.

Our guide to critical illness definitions explains the wording in more detail. For this claim, the useful question is which exact definition and policy version the team is using.

Which medical evidence might the claims team need?

The evidence depends on the condition and the policy test. For a cancer claim, it might include a consultant's report and histology, meaning the laboratory examination of tissue. Where a definition depends on lasting symptoms, a diagnosis letter alone may not answer every part of the test.

A GP's records can provide medical history and dates. A hospital consultant's evidence can explain the diagnosis, test results, procedures and any severity requirements. The insurer may need information from both, or may be able to assess the claim using fewer documents.

The Financial Ombudsman Service says it normally gives greater weight to a specialist consultant's evidence than a GP's when assessing the medical issue. Evidence addressing the policy definition is particularly useful. That does not make the consultant responsible for deciding the insurance claim.

Ask the claims team which existing documents it can use before requesting extra reports yourself. It normally seeks permission before obtaining medical information from the clinicians treating you. Read the permission form and ask about anything unclear, including any option to see a report before it is sent.

You are not expected to interpret test results or persuade a clinician to change their findings. The aim is an accurate account of the medical facts needed for the contract test. Medical questions about diagnosis or treatment belong with your clinical team.

Turn a vague delay into a specific question

Megan, a teaching assistant in Sheffield, is a fictional example. She starts a claim after a cancer diagnosis and sends the clinic letter she already has. The claims team says it still needs medical evidence.

That phrase does not tell her what to do next. Megan asks which document is missing, who has been asked for it and when the request was sent. The handler explains that the hospital's tissue examination report is still outstanding.

She checks that the team has the correct consultant and department. She can then ask the hospital office whether the insurer's request arrived and which department handles it. She does not need to ask for a new medical opinion simply because an existing report has not reached the claims team.

After the report arrives, she asks whether anything else remains outstanding. The insurer may still need to assess the report against her policy or clarify another fact. Receipt of a document is progress, but it is not the same as acceptance of the claim.

The questions help identify a missing request, an administrative problem or an unresolved assessment. They cannot remove a genuine need for further clinical evidence. Megan can also ask for an update date that the handler expects to be realistic.

How long do critical illness claims take?

There is no single timetable that applies to every policy and diagnosis. Notification, gathering evidence, deciding the claim and transferring an accepted payment are separate stages. A published payment target may describe only the last of those stages.

An estimate is more useful when the claims team says what it is based on. Ask whether it assumes all reports have arrived and whether any medical clarification is still needed. You can also ask what the insurer itself is doing next.

Medical reports can take time, but a delay should not automatically be blamed on a GP or hospital. The Ombudsman considers complaints where an insurer had enough evidence to pay earlier. Its published guidance recognises that unnecessary delay can justify compensation.

While the claim is being assessed, policy payments generally still need to continue unless the insurer confirms otherwise. If paying is difficult, ask the insurer about the options before changing a payment instruction. Starting a claim does not itself confirm that the policy has ended.

The guide to when critical illness cover pays out explains the event that triggers payment and timing conditions. Here, keeping track of the outstanding task is more useful than treating an estimate as a deadline.

Is there a critical illness claim time limit?

Check your own policy for notification requirements and tell the claims team about the event promptly. Do not rely on a deadline taken from somebody else's policy or a general article. The event covered by the policy and the date you tell the insurer are separate facts.

If a diagnosis happened some time ago, give the team the dates and explain the delay. Ask for the relevant clause and a written explanation of how it applies. A claim is not necessarily impossible simply because the policy has since ended, but the insured event must satisfy the applicable contract terms.

For example, a fictional bus driver called Idris in Newport finds his paperwork after treatment and realises he has not notified the insurer. His useful starting point is the medical timeline and his policy documents. The insurer needs to establish what happened during cover and how any notification condition applies.

Complaint deadlines are different again. The usual six-month period for taking a complaint to the Ombudsman after a final response is not a general six-month deadline for notifying an illness. A disputed late claim may also involve legal time limits, which need case-specific checking.

What if the claim is refused or keeps stalling?

Ask for the decision and reasons in writing. For a refusal, identify whether the issue is the medical definition, an exclusion, the policy dates or information given when applying. For a delay, ask what evidence is missing and what action the insurer has taken to obtain it.

If the insurer questions an application answer, request the question, your recorded answer and the explanation of why it matters. Different kinds of inaccurate answer can have different consequences. A protection specialist can help you understand the insurance paperwork without deciding the medical facts.

You can complain to the insurer about its decision or handling of the claim. For most complaints of this kind, the business has eight weeks to provide its final response. You can take an eligible complaint to the Financial Ombudsman Service if you remain unhappy or that response period has passed.

The usual referral deadline is six months from the date of the final response, with exceptions in some circumstances. The Ombudsman can consider medical evidence, policy wording and avoidable delay. Our guide to disputes about critical illness cover explains the complaint route further.

What should the acceptance letter confirm?

Ask which benefit has been accepted, how much is payable and who is entitled to receive it. A smaller payment for a less severe condition is often called a partial payment. Its effect on remaining cover depends on the policy terms.

A full critical illness payment commonly ends that cover. If life insurance is linked to it, the effect on the life benefit also needs checking. The acceptance letter should make clear what continues and what ends.

Keep the decision letter with the policy and payment records. A personal lump sum is normally free of income tax, but it can affect means-tested benefits. Our guide explains tax on critical illness payouts and the separate savings rules.

Questions people ask

How do I make a claim on critical illness cover?

Contact your insurer's claims team with your policy details, diagnosis and clinicians' contact details. Ask which forms, permissions and medical evidence it needs, then keep the claim reference and copies of your correspondence.

What is the critical illness claim time limit?

Check the notification requirements in your own policy and contact the claims team promptly. If you are notifying an older diagnosis, give the dates and ask how the policy terms apply rather than assuming it is too late.

How long do critical illness claims take?

Timing depends on the evidence needed, any policy timing conditions and the insurer's assessment. Ask which task remains outstanding and whether a quoted payment timescale starts only after acceptance.

Can I claim critical illness insurance without my policy number?

Insurers can often trace cover using other personal details. Contact the claims team and ask what information it needs to identify your policy.

Can I challenge a refused critical illness claim?

Ask for the reasons, relevant policy wording and evidence, then use the insurer's complaints process if you disagree. An eligible complaint can go to the Financial Ombudsman Service after a final response or the usual eight-week response period.

Sources

We checked this guide against these sources. It is general information, not advice.

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