Critical illness cover. An overview

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4 Critical illness cover and what it does

5 ABI+ definitions

6 Partial payments

7 LV= enhanced benefit features

9 Children’s cover

10 Claims paid in 2014

17 LV= member benefits

18 Making a claim

19 About LV=

The most common causes of a claim 11 Cancer

12 Heart conditions 14 Stroke



We believe that financial protection is a vital part of everyone’s

lifestyle and that’s what’s driven us to look after our customers and

members since 1843

Our critical illness cover has been designed to provide fully comprehensive financial protection. Every condition covered is a potential claim, and financial security at a time when you need to focus on your health and recovery.

Making our cover easy to understand

In this guide we summarise the extensive financial protection offered by our critical illness cover. Ours is one of the most comprehensive policies available, covering 64 illnesses, conditions and treatments.

We explain clearly what you’re covered for, including our full payment definitions, partial payments, and our unique features.

We give you more details about the cover we offer for the five most common reasons for a claim. We also talk about the service and support we can offer you and your family throughout the life of your policy.

Important information:

The headings we use in this document to describe the illnesses covered, are only a guide and refer to our current critical illness product. The full definitions of the illnesses covered and the circumstances in which you can make a claim, can be found in our policy conditions.


Critical illness cover and what it does

Protection for you and your family

If you were diagnosed with a critical illness or suffered a serious accident, it could affect you physically, emotionally and financially. Cover with LV= aims to support you in all three of these areas.

LV= Critical Illness cover is a long-term insurance policy that can also be added to a life insurance policy. It pays you money when you’re diagnosed with one of the conditions or illnesses covered by our policy (and survive for at least 14 days). This payment is a lump sum for either the whole amount of your cover, or a partial payment of up to a maximum of £12,500 or £25,000. We explain more about partial payments later on.

It’s important to understand you’re covered only for the definitions listed in our policy conditions.

You can choose how you want to spend the money you receive, for example, you could;

pay off all or part of your mortgage pay bills and outstanding loans and debts

make alterations to your home that you may need to help you get around easier

allow your partner or a family member to take time off work to support you at home


ABI+ definitions

Means more comprehensive cover

The Association of British Insurers1 (ABI) sets out ‘standard’ industry medical definitions for 23 conditions to help people understand what they’re covered for when they buy a critical illness policy This is known as the ‘Statement of Best Practice for Critical Illness Insurance’2. We’ve chosen to offer broader cover than the ABI definition for 19 of these conditions and we refer to these conditions as ‘ABI+’.

The conditions listed below are all covered with an ABI+ 2 definition. The wording in italics is the same as in our policy conditions and tells you what’s required for a claim to be paid.

LV= ABI+ conditions

Alzheimer’s disease -

resulting in permanent symptoms

Aorta graft surgery -

for disease or traumatic injury

Benign brain tumour Cancer -

excluding less advanced cases

Coma - resulting in permanent


Coronary artery bypass grafts Deafness -

permanent and irreversible

Heart attack - of specified severity Heart valve replacement or repair HIV infection - caught in a specified

list of countries from a blood transfusion, a physical assault, or at work

Loss of hands or feet -

permanent physical severance

Major organ transplant Motor neurone disease -

resulting in permanent symptoms

Multiple sclerosis -

with persisting symptoms

Paralysis of a limb -

total and irreversible

Parkinson’s disease -

resulting in permanent symptoms

Stroke - of specified severity Terminal illness

Third degree burns -

covering 20% of the body’s surface area or affecting 50% of the area of the face or head

1 ABI (Association of British Insurers) represents the UK insurance industry with the government,

regulators and policy makers in the UK, EU and internationally and sets out the ‘standard’ medical definition for 23 of the main critical illness conditions we cover.

2 The current Statement of Best Practice for Critical Illness Insurance is dated 2011 and is being

replaced in December 2015 with the Statement of Best Practice for Critical Illness Insurance 2014. Our ABI+ conditions are based on the current 2011 definitions. What you’re covered for and what we would pay a claim for, are not affected.




You can claim for less

severe conditions and your

policy remains in place

In the past, critical illness cover provided protection against life threatening illnesses. A claim would be made and the policy would end.

Medical advancements have now made some of these conditions less ‘critical’ and whilst it’s entirely possible to make a full recovery from some less severe conditions such as non-invasive cancer, the financial and emotional impact on you and your family can still be devastating.

We offer 20 partial payment definitions, with payments of either 12.5% to 25% of your cover. And after we’ve made a payment, your policy remains in place and for the full amount of your cover. A partial payment can help to relieve financial pressure so you can concentrate on your health and treatment.

However, it’s important to be aware that if you’re diagnosed with a condition that meets our definition for both a partial payment and a full payment, we’ll only pay the claim for the full payment condition, and your policy will end.

Example: how our partial payments work - This is an extreme example but it’s

designed to demonstrate how our partial payments work alongside a full payment. Mr Smith takes out a critical illness policy with cover for £100,000. He suffers with two of the conditions covered by a partial payment, he then goes on to suffer and survive a heart attack.

Condition Claim type Year of

claim Amount he receives Prostate cancer partial payment 2014 £25,000*

Cardiomyopathy partial payment 2014 £25,000* Heart attack full payment 2015 £100,000

Even though his original cover was for £100,000, LV= would pay him a total of £150,000

* Payment is 25% of cover up to a maximum of £25,000 Accident hospitalisation cover -

25% of cover up to £25,000 Arteriovenous malformation of the brain - with specified treatment 12.5% of cover up to £12,500 Carcinoma in-situ of the cervix uteri - with specified treatment

12.5% of cover up to £12,500 Carcinoma in-situ of the urinary bladder -

12.5% of cover up to £12,500 Carotid artery stenosis - treated by

endarterectomy or angioplasty

12.5% of cover up to £12,500 Central retinal artery occlusion -

resulting in permanent visual loss

12.5% of cover up to £12,500 Cerebral aneurysm - with surgery

or radiotherapy

12.5% of cover up to £12,500 Coronary artery angioplasty - 25% of cover up to £25,000 Diabetes mellitus type 1 - requiring

permanent insulin injections

12.5% of cover up to £12,500 Ductal or lobular carcinoma in-situ of the breast - with

specified treatment 25% of cover up to £25,000 Non-severe cardiomyopathy - definite diagnosis 25% of cover up to £25,000 LV= partial payments

Ovarian tumour - of borderline

malignancy/low malignant potential with surgical removal of an ovary

12.5% of cover up to £12,500 Partial loss of hearing -

of specified severity

12.5% of cover up to £12,500 Partial loss of sight -

permanent and irreversible

12.5% of cover up to £12,500 Partial third degree burns -

covering 10% of the body’s surface area or affecting 25% of the area of the face or head

12.5% of cover up to £12,500 Prostate cancer

25% of cover up to £25,000 Removal of one or more lobe(s) of the lung - for disease or trauma 12.5% of cover up to £12,500 Severe crohn’s disease -

surgically treated

12.5% of cover up to £12,500 Severe ulcerative colitis -

with operation to remove the entire large bowel

12.5% of cover up to £12,500 Testicular carcinoma in-situ -

requiring surgery to remove at least one testicle


150% of cover for neurological conditions diagnosed under age 45

We offer enhanced payments for six neurological conditions. We’ll pay you one and a half times your cover (150%) if you’re under the age of 45 and have been diagnosed with of one the conditions opposite. The enhanced payment can be up to an additional £200,000 on top of your original cover.

Being diagnosed with a critical illness at any age is devastating but being diagnosed at a younger age can have an even bigger impact as you’re more likely to;

be working and earning an income at the time of diagnosis have a partner who still works and so unable to look after you have dependent children

have ageing parents who need caring for have been more physically fit and active

have financial commitments, such as a mortgage or loan.

For example

Mr Smith has cover of £100,000; he’s diagnosed with Parkinson’s disease at age 38. He’ll receive a payment from us of £150,000 (1.5 x £100,000).

Mrs Brown, also aged 38 is diagnosed with Motor neurone disease and has cover of £450,000; she’ll receive a payment from us of £650,000 (enhanced payments are limited to an extra £200,000).

LV= enhanced payments

We offer enhanced claim payments for 16 specified conditions

Experiencing a critical illness at an earlier age or as a result of an accident can mean living with a life-changing condition for many decades. This could potentially affect your finances and lifestyle for the rest of your life. Our unique enhanced payment definitions have been designed to pay you more money than the original amount you’ve insured yourself for.

Enhanced payment neurological conditions

Alzheimer’s disease -

resulting in permanent symptoms

Dementia (including senile dementia) -

resulting in permanent symptoms

Motor neurone disease -

resulting in permanent symptoms

Multiple system atrophy -

resulting in permanent symptoms

Parkinson’s disease -

resulting in permanent symptoms

Progressive supranuclear palsy -


200% of cover for accidents

If your claim is as a direct result of an accident, and for one of the ten conditions shown below, we’ll pay you twice the amount of your original cover, up to an additional £200,000.

Generally speaking, an accident is an incident that occurs entirely by chance. There are a number of things we won’t consider an accident. For example, an intentional self-inflicted act. For more details of what we do and don’t consider an accident, please refer to our full policy conditions.

An example of how the accident enhanced payment works

Mr White has cover of £100,000 and has to have his leg amputated as a direct result of a car accident. He’ll receive a payment of £200,000 (2x cover of £100,000). Ms Jones has cover of £500,000 and suffers a traumatic head injury after a horse riding accident. She’ll receive a payment of £700,000 (enhanced payments are limited to an extra £200,000).

Accident enhanced payment conditions

Blindness - permanent and irreversible Coma - resulting in permanent symptoms Deafness - permanent and irreversible

Loss of hands or feet - permanent physical severance

Loss of independent existence - unable to look after yourself ever again Loss of speech - permanent and irreversible

Paralysis of a limb - total and irreversible Surgical removal of an eyeball

Third degree burns - covering 20% of the body’s surface area or affecting 50%

of the area of the face or head


“Everybody thinks it’s never going to happen to them and we thought the same, but not anymore, it happened in the blink of any eye and in a moment everything changes.”

Jeremy and Nicola Krzystyniak

Critical illness customers - children's claim

Children’s cover

Our children’s cover is automatically added to your policy at no extra cost

No one ever wants to imagine their child becoming

critically ill, but sadly it does happen. Our children’s cover is automatically included in your critical illness policy and even if you don’t have children now, they’ll still be covered if you have a family in the future. In 2014 4% of our critical illness claims were paid to parents of very sick children with the majority of these claims relating to cancer and cancer related illnesses. The money gives parents options and breathing space. It can be used to;

take time off work or leave work

make necessary adjustments to the home or family car

pay for private treatment or therapies pay for travel expenses

What we cover

We provide cover from birth up until their 21st

birthday. And your children are covered for all the same conditions, illnesses and treatments as the main policy, except for total permanent disability and our partial payment for diabetes type 1.

Please note: We’ll also pay a claim if your child is born with one of the conditions listed in the policy as long as the symptoms hadn’t arisen before your policy started.

What we pay

Children’s cover is similar to a partial payment in that a claim won’t affect your main policy. We’ll pay 50% of your cover up to a maximum of £25,000 for a single policy and £50,000 if you have more than one critical illness policy with us.


Claims paid in 2014

Five common causes accounted for nearly 95% of LV= critical illness claims in 2014

The top five reasons for paying a critical illness claim were; Cancer, Stroke, Heart attack (including other heart conditions*), MS and Total permanent disability. Together these accounted for over 95% of all critical illness claims paid in 2014.

*Heart attack – 7%, other heart conditions – 5% (12%)

Child claims accounted for 4% of all critical illness claims

Cancer 67%

Stroke 9%

Heart attack 7% Other heart conditions 5% Multiple sclerosis 5% Total permanent disability 3% Parkinson’s and other neurological 2%

Others 3%

Overall claims



Cancer is the most common cause of LV= critical illness claims, accounting for

67% of claims in 2014

The most common causes of a claim

We provide one full payment condition and six partial payment conditions relating to cancer. Macmillan cancer support estimate that by the end of 2016, there will be more than 1,000 people diagnosed with cancer every day in the UK. Breast cancer and prostate cancer are the most common female and male cancer claims we see. In 2014 breast cancer accounted for 54% of all female cancer claims and prostate cancer for 23% of all male claims. Depending on the severity of the cancer, it may be paid under a full claim payment or a partial payment up to £25,000.

Full payment ABI+ condition - for more severe and advanced forms of cancer

Cancer can affect any part of the body and our definition would give you a payment for the full amount of your cover. This definition is designed to cover more serious and invasive forms of cancer. Less severe forms, such as a carcinoma in-situ diagnosis, may be covered by one of our partial payments.

Partial payments

Ductal or lobular carcinoma in-situ of the breast - 25% of cover up to a maximum of £25,000. Prostate cancer - 25% of cover up to a maximum of £25,000.

When prostate cancer is diagnosed it’s usually given a severity level based on a number of clinical classifications and this would dictate whether we made a full or partial payment.

What is Carcinoma in-situ?

Carcinoma in-situ is a term used to describe a cancer that is only present in the cells where it started, and has not spread to any nearby tissues. For example, the earliest stage of breast cancer would be called carcinoma in-situ of the breast or the earliest stage of cervical cancer might be called carcinoma in-situ of the cervix.

We provide cover for four ‘carcinoma in-situ’ conditions.

Name Partial payment Affects

Ductal or lobular carcinoma in-situ

of the breast 25% of cover up to a maximum of £25,000 Men/women

Carcinoma in-situ of the cervix uteri 12.5% of cover up to a maximum of £12,500 Women

Carcinoma in-situ of the urinary bladder 12.5% of cover up to a maximum of £12,500 Men/women

Testicular carcinoma in-situ 12.5% of cover up to a maximum of £12,500 Men


The most common causes of a claim

Heart conditions

Heart attacks account for 7% of our critical illness claims and other heart related

conditions account for 5% of claims

Heart attack - (ABI+) full payment condition

A heart attack happens when one of the three arteries that feed the heart muscle become completely blocked. The area of the heart being supplied is damaged or dies. A heart attack is known medically as a Myocardial infarction and means damaged heart muscle.

To accurately diagnose a heart attack a number of tests are carried out:

An electrocardiograph (ECG) to show changes in the electrical activity of the heart (or findings on a heart scan)

Blood tests to establish levels of cardiac enzymes or Troponins (proteins)

If the ECG shows a change in the electrical activity of the heart and the enzymes levels rise, we accept this as evidence of a heart attack and do not require the rise to meet a specified level.

Around 175,000 people suffer a heart attack in the UK each year*.


Full heart conditions

Aorta graft surgery - for disease or traumatic injury Cardiac arrest

Cardiomyopathy - of specified severity Coronary artery bypass grafts Heart attack - of specified severity Heart valve replacement or repair

Idiopathic arterial pulmonary hypertension -

of specified severity

Open heart surgery - with surgery to divide

the breastbone

Pulmonary artery surgery - for disease only

Partial payment heart conditions

Non severe cardiomyopathy - definite diagnosis Carotid artery stenosis - treated by endarterectomy

or angioplasty

Coronary artery angioplasty


Cardiac arrest - Full payment condition

A cardiac arrest differs from (but can be caused by) a heart attack in that the heart stops pumping blood around the body. A cardiac arrest can happen to anyone at any age and a heart attack is usually linked to an unhealthy lifestyle or older age. The most common cause of a cardiac arrest is an abnormal heart rhythm called ventricular fibrillation. Ventricular fibrillation occurs when the electrical activity of the heart becomes so chaotic that the heart stops pumping and quivers or ‘fibrillates’ instead.

Cardiomyopathy - Full payment condition and Partial payment condition

Cardiomyopathy is a disease of the heart muscle. There are four main types and dilated cardiomyopathy (DCM) is the most common. DCM can affect children and adults but is most common in middle-age men.

About 2 in 10,000 people in the UK develop DCM each year*.


Aorta graft surgery - (ABI+) Full payment condition

The aorta is the main blood vessel in the body. Blood is pumped from the heart and passes across the aortic valve (one of four valves in the heart), and then through the aorta, where it is then distributed through a system of smaller arteries. Our definition includes grafts to the thoracic and abdominal aorta but not the smaller arteries that branch off of the main aorta blood vessel.

Our definition includes surgery for traumatic injury as well as disease.

Coronary artery bypass grafts - (ABI+) Full payment condition

A coronary artery bypass graft (CABG) is a surgical procedure used to improve the blood flow and oxygen supply to the heart when arteries have become narrowed by the build up of fatty deposits.

Each year around 17,000 CABG procedures are performed in the UK*.


Coronary artery angioplasty - Partial payment condition

Coronary artery angioplasty is another procedure used to open narrowed or blocked arteries. The artery is widened when a stent (a short wire mesh tube) is inserted into the relevant artery to allow the blood to flow more easily.

This is often used to relieve symptoms such as angina and shortness of breath.

Heart valve replacement or repair - (ABI+) Full payment condition

There are four valves in your heart making sure that blood flows in and out of the heart in the correct direction. There are two types of valve surgery:

- Valve repair: Often used when a valve leaks but is not seriously damaged.

- Valve replacement: The diseased valve needs to be removed and replaced with a new valve.

Open heart surgery - Full payment condition

Open heart surgery is any surgery where the chest is opened and surgery is done on the heart muscle, valves, arteries, or other parts of the heart (such as the aorta). The term “open” means that the chest is “cut” open. If the breast bone is divided and surgery is carried out, a full payment claim will be paid.



In 2014, strokes accounted for 9% of all our critical

illness claims

For the brain to function, it needs a constant blood supply to provide vital nutrients and oxygen to the brain cells. A stroke happens when the blood supply to part of the brain is cut off and brain cells are damaged or die. Strokes affect people in different ways, it depends on the part of the brain that has been affected, the severity of the attack and how healthy the person was before the stroke. Half of all stroke suffers have a disability, such as weakness and paralysis, problems with walking and difficulty balancing. Other common problems after a stroke include communication, cognitive and emotional issues.

Half of all stroke patients suffer with a disability, such as weakness, paralysis and difficulty with walking and balancing. Other common problems after a stroke include communication, cognitive and emotional issues, resulting in a significant change to the lifestyle previously enjoyed.

Stroke - (ABI+) Full payment

We’ll pay a stroke claim on diagnosis, this means you won’t need to wait for your money while the consultant decides if your symptoms are permanent or not. Before we pay you, all we require is that you’ve been diagnosed as having had a stroke with 24 hours of persisting clinical symptoms.

The stroke association estimate that 152,000 people suffer a stroke in the UK each year, that’s one every 3 minutes and 27 seconds. They can affect young people, children and babies*.


Multiple sclerosis

In 2014, multiple sclerosis accounted for 5% of all our critical

illness claims

Multiple sclerosis (MS) is a neurological condition affecting the central nervous system. The immune system, which normally helps to fight off infections, mistakes myelin (the coating around the nerve fibres) for a foreign body and attacks it. This damages the myelin and strips it away, either partially or completely, leaving scars known as lesions or plaques. This damage disrupts messages travelling along the nerve fibres meaning they can slow down, become distorted, or not get through at all.

ABI+ full condition payment for multiple sclerosis

Our definition will pay a claim after three months of persisting clinical symptoms or immediately on evidence of two or more attacks of impaired motor or sensory function. As long as this is evidenced with a MRI scan, a normal procedure when a diagnosis is being made.

MS affects around 100,000 people in the UK and most people are diagnosed between the ages of 20 and 40. More women than men are diagnosed and it can also affect young children*.



Total permanent disability

Total permanent disability accounted for 2% of all the critical illness

claims we paid in 2014

Our Total permanent disability definition is optional and can be included in your policy for an additional cost.

This covers you if you have an illness or injury that leaves you permanently unable to work in your own job, or able to complete a number of everyday tasks, for the rest of your life.

Please note: This definition is excluded from our children’s cover.

What are the risks of suffering with a serious illness and being unable to work?

According to the LV= Risk Reality Calculator, a 41 year old female non- smoker has a 12% risk of suffering a serious illness and a 6% risk of dying, before retirement. A male at the same age and also a non-smoker, has a 15% of suffering a serious illness with a 7% of death before retirement.

The most common causes of a claim

Ask your adviser to run your details through our Risk Reality Calculator to see your own

personal results.


Every single customer who buys an LV= protection product automatically becomes a member of the society. Looking after and supporting our members is at the heart of everything we do. We care about you and your family and we’ll try and help you whenever we can.

We give all our members exclusive access to a range of support services that we feel offers you something that can make life flow a little easier when it’s needed.

You can find out more about membership in the ‘About LV=’ section on page 19.

LV= Health and Wellbeing Line

Our health and wellbeing line is available 24 hours a day, 7 days a week, to support members with any health, medical or wellbeing questions.

Health advice and telephone counselling

You’ll have access to a team of trained medical professionals who will be there to offer practical advice and support on any aspect of your health and wellbeing. This could be anything from childcare issues, to what to expect if you (or a member of your family) need to have an operation.


Some people find it easier to talk to a stranger than to relatives or friends.

Our experienced counsellors will be able to give you advice on how to cope with any issues you may be facing. Including things like relationship difficulties, bereavement or stress. To make things even easier, you can choose to work with the same counsellor on an on-going basis.

Legal advice service

Knowing your rights and what you’re entitled to can make life a lot easier sometimes. Putting up with a noisy neighbour or a pushy landlord for example, can add unnecessary stress to your life.

Our legal advice line gives you access to fully qualified solicitors and lawyers without the associated costs. The legal team have experience in over 100 areas of law, including;

Employment - unfair dismissal, redundancy and discrimination

Family law - child maintenance, divorce and domestic violence

General law - civil litigation, motoring offences, debt advice and personal injury

Property - nuisance neighbours, home purchase and access rights

Private - client wills, trusts, powers of attorney and probate

Your say in how LV= is run

Once you’ve been a member for over 12 months (and are over age 18), you’ll be able to vote and attend our Annual General Meetings and have a say in how we run the company.

Member discounts

As a member you could save money on LV= car, home and travel insurance.

To find out more about what it means to be a member of LV= please ask your financial adviser or visit us at

LV= member benefits


Making a claim

Support before, during, and after a claim

When you need to make a claim you can contact us in a number of different ways; phone, email or letter. As soon as we receive your claim, we allocate you a personal claim consultant and they will start reviewing your claim immediately.

We’ll usually need some evidence from your doctor (or the medical practitioner who is treating you) to confirm your diagnosis. We may also need to get medical reports from your doctor. If we do, we’ll send you a consent form for you to complete. Your personal claims assessor will give you their direct contact details and you can call or email them directly whenever you have any questions. Our consultant will deal with all aspects of your claim, from the first phone call to making sure you receive your money as quickly as possible.

On average we pay a critical Illness claim within 6 weeks. This can be a lot quicker if we receive all the medical evidence promptly. We understand that it’s a very emotional time when you or a family member are making a claim. We’ll support and guide you gently through the process and, where needed, chase your doctor for the relevant medical evidence so that you receive your money quickly.


About LV=

We’re the UK’s largest friendly society and a leading financial mutual

company. We have over 6,000 employees, 1.1m members1 and

4.4m customers2

As a mutual we have no shareholders, so are truly focused on putting our members first and ensuring that they benefit from everything we do.

Our roots go all the way back to 1843. And although LV= has changed a lot, our core values remain the same; to provide financial security to each and every one of our members and customers.

1 If you buy a protection product or retirement and investment policy with us, you become a member and

owner of the society with certain benefits and rights. Ask your adviser for more information about being a member of LV=.

2 You’re a valued customer if you own one of our general insurance products such as home, car and

travel insurance.

Important information:





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