Critical illness cover An overview guide

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Critical illness cover

An overview guide



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 available, covering 59 illnesses, conditions and treatments.

We explain clearly what you’re covered for, things such as ABI+ conditions and partial payments, and tell you about the unique features from LV=.

We outline the cover we provide for the five most common causes of claims, which accounted for over 93% of LV= claims in 2012. And we also talk about the service and support we can offer you and your family before, during and after a claim.


4 Claims in 2012

5 Critical illness cover and what it does

6 ABI+ definitions

7 Partial payments

8 LV= enhanced benefit features

17 Member benefits

18 Making a claim

19 About LV=

Most common causes of a claim

10 Cancer

11 Heart conditions

14 Neurological conditions

15 Stroke


Claims in 2012

Five common causes accounted for 93% of

LV= critical illness claims in 2012

Most common conditions % of total claims

Cancer 64.8%

Heart attack and heart related 18.2% Parkinson’s disease / other neurological conditions 4.5%

Stroke 4.5%

Multiple sclerosis 1.1% All other conditions 6.9%


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 tomorrow, how would this affect you and your family, both financially and emotionally? How would you pay for any adaptions to your home if they were needed, or any extra medical or recuperative care? LV= critical illness cover is a long-term insurance policy that can also be added to a life insurance policy. If you are diagnosed with a certain illness or condition as specified in our insurance policy conditions, and you survive for at least 14 days, we will give you a tax free lump sum payment. It’s important to understand you’re covered only for conditions listed in our policy conditions and no others.

You can choose how you want to spend the money, for example:

pay off all or part of your mortgage pay bills and outstanding loans and debts make alterations to your home

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

pay for private treatment such as reconstructive surgery, rehabilitation or complementary therapies cover the cost of additional care or help around


ABI+ definitions

Means more comprehensive cover

The Association of British Insurers1 (ABI) sets out ‘standard’ industry medical definitions for 23 conditions. We’ve chosen to broaden the definition for 18 of these conditions, so it’s more likely that we’re able to pay your claim. We refer to these broadened conditions as ‘ABI+’.

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 symptoms

Coronary artery bypass grafts Heart attack -

of specified severity

Heart valve replacement or repair HIV infection -

caught in a specified list of counties 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 -

resulting in permanent symptoms

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. We’ve chosen to broaden 18 of these 23 definitions to provide you with better cover.



partial payments

You can claim for less

severe conditions

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 cancers or a minor heart attack, the financial and emotional impact on you and your family can still be devastating. We now offer partial payments for 16 conditions where, on diagnosis of one of these specified conditions, you’ll receive an amount equal to a percentage of your cover, ranging from 12.5% to 25%. And although we’ve made a payment, we don’t reduce your amount of cover; your policy still remains in place for the full amount of your original cover.

A partial payment can help to relieve financial pressure whilst you concentrate on your health and treatment, without your recovery being impeded by worrying about bills.

Example: how a partial payment works Whilst this example is extreme, it’s designed to demonstrate how partial payments work alongside full payments.

Mr Smith takes out a critical illness policy with cover for £80,000. He is extremely unlucky and suffers with two of the conditions covered by a partial payment, he then goes on to suffer and survive a serious heart attack.

Condition Claim type Year of


Amount he receives Prostate cancer partial payment 2013 £20,000* Cardiomyopathy partial payment 2013 £20,000* Heart attack full payment 2017 £80,000 Even though his original cover amounts to £80,000, LV= would pay him a total of £120,000

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

LV= partial payments

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 at the same time – we’ll only pay the claim for the full payment condition, and your policy will then end. In other words we won’t pay both a full payment and a partial payment at the same time.

Accident hospitalisation cover - 15% up to £15,000

Arteriovenous malformation of the brain -

with specified treatment 12.5% up to £12,500 Carcinoma in-situ of the cervix uteri -

requiring treatment with hysterectomy

12.5% up to £12,500 Carcinoma in-situ of the urinary bladder - 12.5% up to £12,500 Coronary artery angioplasty - 25% up to £25,000 Ductal or lobular carcinoma in-situ of the breast - with specified treatment 12.5% up to £12,500 Minor heart attack - definite diagnosis 25% up to £25,000 Minor stroke - definite diagnosis 25% up to £25,000

Non severe Cardiomyopathy - definite diagnosis

25% up to £25,000 Partial loss of sight - permanent and irreversible 12.5% 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% up to £12,500 Prostate cancer - 25% up to £25,000 Removal of one or more lobe(s) of the lung - 12.5% up to £12,500 Severe ulcerative colitis - with operation to remove the entire large bowel

12.5% up to £12,500 Severe Crohn’s disease - surgically treated 12.5% up to £12,500 Testicular carcinoma insitu -requiring surgery to remove at least one testicle


1.5x cover for neurological conditions diagnosed

under age 45

We cover a number of neurological conditions and in 2012 we saw an increase in claims for these types of conditions such as Parkinson’s disease and dementia.

Being diagnosed with any 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

have dependent children

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

have heavy financial commitments, such as a mortgage or loan We now offer enhanced payments for six neurological conditions. We’ll pay you one and a half times your cover if you’re under age 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.

For example

Mr Smith has taken 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 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).

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 -

resulting in permanent symptoms

LV= enhanced payments

We now offer enhanced payments for 16 specified conditions

Experiencing a critical illness at an earlier age or as a result of an accident can mean people live with a life-changing condition for many decades. This could potentially affect their finances and their lifestyle for the rest of their lives.


Blindness -

permanent and irreversible Loss of speech - permanent and irreversible Coma -

resulting in permanent symptoms Paralysis of a limb -

total and irreversible

Loss of independent existence - unable to look after yourself ever again

Deafness -

permanent and irreversible Surgical removal of an eyeball Loss of hands or feet - permanent physical severance Third degree burns -

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

Traumatic head injury -

resulting in permanent symptoms

2x cover for accidents

For ten conditions, we’ll pay you twice the amount of your original cover up to a maximum of £200,000 if the cause is as a direct result of an accident.

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, any illness, disease or other natural cause or an intentional self-inflicted act. For us to pay an enhanced payment claim, we explain what we mean by an ‘accident’ in our policy conditions.

Accident enhanced payment conditions

An example of how the accident enhanced payment works Mr White has taken 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 taken 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).


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 12.5% up to £12,500 Men/women Carcinoma in-situ of the cervix uteri 12.5% up to £12,500 Women Carcinoma in-situ of the urinary bladder 12.5% up to £12,500 Men/women Testicular carcinoma in-situ 12.5% up to £12,500 Men


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

63% of claims in 2012. We provide one full payment condition and six partial

payment conditions related to cancer.

Full payment condition - for more severe

and advanced forms of cancer

Cancer can affect any part of the body and our ABI+ condition would give you a payment for the full amount of your cover. This policy definition is designed to cover more serious and invasive forms of cancer, so there will be occasions which won’t be covered, for example a less severe form of cancer such as carcinoma in-situ or a less aggressive form of skin cancer.

Around 55,000 people are diagnosed with breast cancer each year in the UK. That’s one person every 10 minutes. Breast cancer also affects men, but it’s rare – around 400 men are diagnosed each year.*


Partial payments

Prostate cancer – partial payment of 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.

Prostate cancer is the most common form of cancer in men, in the UK. 1 in 8 men will suffer with prostate cancer in their life and 100 men are diagnosed every day.*

* Most common causes of a claim


Heart attack

and heart related


Heart conditions accounted for 18% of

our critical illness claims in 2012

We provide nine full payment conditions and three partial payment conditions relating to the heart.

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

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 Minor heart attack - definite diagnosis

Coronary artery angioplasty


Heart attack

and heart related


Heart attack - (ABI+) full payment condition and

partial payment condition

A heart attack happens when one of the three arteries that feed the heart muscle, become completely blocked. If the blockage is not removed a part of the heart can die. A heart attack is known medically as a myocardial infarction or MI, and is a serious medical emergency; however many people make a full recovery and within a few months are able to return to their normal lives.

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

If the Troponin levels are above a certain threshold then this would usually mean a more serious heart attack and therefore likely to receive a full payment. If the Troponin levels are below a certain level then this would qualify for our partial payment condition (please see the policy conditions for more information).

Our ABI+ definition means we’ve removed the requirement for evidence of ‘typical clinical symptoms’. Deaths from heart attack in England have halved since 2002 and the British Heart

Foundation estimates that there are around 103,000 heart attacks in the UK every year*.

*BHF Coronary heart disease statistics 2012 Most common causes of a claim


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. 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.

A cardiac arrest can happen to anyone at any age and a heart attack is usually linked to an unhealthy lifestyle or older age.

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 and 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.

Every year, 28,000 CABGs are performed in the UK. Nearly 80% of those who need to have the operation are men over 60 years old*.


Coronary artery angioplasty - (ABI+) Full Payment condition and 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: t7BMWFSFQBJS0GUFOVTFEXIFOBWBMWFMFBLTCVUJT

not seriously damaged.

t7BMWFSFQMBDFNFOU5IFEJTFBTFEWBMWFOFFETUPCF 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.


Neurological conditions

The proportion of LV= critical illness claims for

neurological conditions increased in 2012.

Neurological conditions result from damage to the brain, spinal column or nerves, caused by illness or injury and can affect anyone at any age. Some neurological conditions are life threatening and most of them severely affect people’s quality of life and many cause life-long disability.

Alzheimer’s disease is the most common form of dementia. These conditions mainly affect older people and there are more than 500,000 people in the UK with Alzheimer’s2.


LV= neurological conditions:

Alzheimer’s disease -

resulting in permanent symptoms

Dementia (including senile dementia) -

resulting in permanent symptoms

Multiple system atrophy -

resulting in permanent symptoms

Motor neurone disease -

resulting in permanent symptoms

Parkinson’s disease -

resulting in permanent symptoms

Progressive supranuclear palsy -

resulting in permanent symptoms Most common causes of a claim



For the brain to function, it needs a constant blood supply, which provides 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, depending on the part of the brain that has been affected, the severity of the attack and how healthy the person was before the stroke. About a third of people who have a stroke make a significant recovery within a month*. But for most stroke survivors there can be longer lasting effects or ‘persisting clinical symptoms’ (PCS). It can take a year or longer for a recovery and in severe cases a stroke can result in long-term disability.

Stroke – (ABI+) Full payment and partial payment definitions

If the stroke doesn’t initially result in persisting clinical symptoms then we will make an advance payment equal to 25% of your full amount of cover (maximum £25,000). Then if within 12 months of the initial stroke the symptoms persist and do result in a diagnosis of persisting clinical symptoms then we’ll pay the balance of the full amount of cover and the policy will then end.

If after 12 months, there are no permanent symptoms then we’ll reinstate cover to the full amount of cover and treat the advance payment we made as an additional partial payment for a minor stroke. Cover would then continue in full for the remaining 58 conditions, including the full payment Stroke condition.


Multiple sclerosis

Multiple sclerosis (MS) is a neurological condition affecting the central nervous system. The immune system, which normally helps to fight off infections, mistakes myelin for a foreign body and attacks it. This damages the myelin and strips it of the nerve fibers, either partially or completely, leaving scars known as lesions or plaques.

This damage disrupts messages travelling along the nerve fibers – they can slow down, become distorted, or not get through at all.

We provide an ABI+ full condition payment for multiple sclerosis.

MS affects around 100,000 people in the UK and most people are diagnosed between the ages of 20-40. Three times as many women have MS as men.*

* Most common causes of a claim


LV= member benefits

Exclusive help support and savings

You automatically become a member of LV= when your critical illness cover starts and entitled to access a range of help and support services, and savings on other LV= products.

Member Care Line

The Member Care Line is available 24 hours a day to support members with any queries or concerns.

If you’ve got a question or a problem, one of our experts is here to help.

Health matters and telephone counselling

If you are worried about an aspect of your health or would like to speak to a counsellor about the way you feel – qualified nurses and experienced counsellors are available to take your call day or night.

Legal advice service

Specialising in the following categories of law:

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

Our members are entitled to vote and attend our Annual General Meetings which are usually held in spring. If you are a member we’ll invite you to participate. Those who have been a member for at least 12 months and are over 18 can vote.

Member discounts

Members get more. As a member you can save money on LV= car, home, travel and pet insurance.

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


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, and once we’ve received this we’ll start reviewing it immediately.

We’ll usually need 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.

You’ll have your own dedicated claims consultant who’ll give you their contact details. You can call or email them directly whenever you have any questions. Your claims 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 is 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 you receive your money quickly and can then concentrate on your recovery.

Last year we paid 91.4% of our critical illness claims. We had to decline 2.2% of our claims because the claim didn’t meet the policy definition. We didn’t pay 6.5% of claims because the customer had not told us something about their medical history when they made their application. So it’s very important when you apply that you tell us everything about your medical history. If you’re not sure if it’s relevant or not, it’s always better to tell us anyway.


About LV=

With over 5,600 employees working in 17 offices across the UK, we are the UK’s largest friendly society and a leading financial mutual, with more than five million members and customers*.

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

Our roots go all the way back to 1843, when we welcomed our first customers. LV = has changed a lot over the last few years and our success during this time has been down to a number of things. We want to deliver value for our members and we want to be different and distinctive in the way we do business.

Our three guiding principles are: Offering great value

Being easy to do business with Having a caring approach

*as at 31/12/12

Important information:

Our critical illness policy covers 59 conditions, illnesses and treatments listed in the main policy conditions. More details are available from your financial adviser.

If you stop paying your premiums your cover could stop and you won’t get any of your money back.

Any references we make to taxation are based on our understanding of current legislation and HM Revenue & Customs practice, which can change.