critical illness

Critical illness definitions


Critical illness cover means insurance which pays out on meeting the policy definition of a specified critical illness.

Insurance companies may not cover all these critical illnesses but if they do, they must meet the standards set out in the Association of British Insurers guide (ABI). Some insurance companies will offer better cover than the ABI definitions as well as covering a wider range of illnesses than those laid out by the ABI.


The top 5 claims made under critical illness plans are: –



Cancer is the single biggest critical illness risk we all face. Cancer Research UK estimates that more than 1 in 2 people in the UK will develop cancer during their lifetime.1

But the good news is more people are surviving cancer than ever before due to early detection and diagnosis.

Cancer is a disease where cells grow out of control and invade, erode and destroy normal tissue.

These cancerous cells can form into clusters known as malignant tumours. Cancer can happen anywhere in the body and there are over 200 different types of cancer. A few cancers don’t actually have cancer in their name (e.g. leukaemia) – but they’re still cancers.

Some cancers are more easily treated than others, for example, early stage prostate cancer and skin cancers that are not invasive. Other cancers which are often easily treated and where the sufferer has a good chance of a full recovery include those that are isolated, not yet malignant and have not yet spread through the body.  These cancers are known as cancers in situ, pre-malignant tumours and non-invasive tumours and are often described as having either borderline malignancy or having low malignant potential.


Heart Attack

Like any muscle in the body the heart needs oxygen from the blood to work properly. The heart is also responsible for pumping blood around the body. A heart attack happens when the blood supply to part of the heart muscle is severely reduced or stopped. The medical term for heart attack is myocardial infarction.

The reduction or stoppage happens when one or more of the arteries supplying blood to the heart muscle is blocked. This is usually caused by the build up of fat-like substances which eventually burst, tear or rupture, creating a ‘snag’ where a blood clot forms and blocks the artery.

This leads to a heart attack. If the blood supply is cut off for more than a few minutes, a portion of the heart muscle will suffer permanent injury and die. An electrocardiograph measures electric currents associated with the heart contractions and these will be altered when someone suffers a heart attack. Blood tests will also show a rise in certain chemicals in the blood, such as troponins and cardiac enzymes following a heart attack.

Angina sufferers experience symptoms similar to a heart attack but part of the heart muscle doesn’t die as a result.



A stroke happens when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When this happens brain cells are killed and this affects speech, movement, and memory.

The specific abilities lost or affected depend on where in the brain the stroke takes place and on the size of the stroke. For example, someone who has a small stroke may experience only minor effects such as weakness of an arm or leg, but someone who has a bigger stroke may be left paralysed on one side, lose the ability to speak or, in severe cases, die.


Multiple Sclerosis (MS)

Multiple sclerosis (MS) is an incurable disease of the central nervous system. The central nervous system is made up of the brain and the spinal cord which the brain uses as the central message system to the rest of the body. Surrounding and protecting the nerve fibres of the central nervous system is an important substance called myelin. This substance helps messages travel quickly and smoothly from the brain to the rest of the body.

MS causes the body’s immune system to attack the myelin surrounding the nerve fibres. This damage to myelin disrupts messages travelling along nerve fibres leading to messages slowing down, becoming distorted, or not getting through at all.


Children’s Critical Illness

Critical illness cover can include children’s benefit. This means that all of your natural, step or legally adopted children and any future children could be covered under the terms of the policy (except for total permanent disability and terminal illness) and for death during the period of cover.

Children’s benefit could be paid if a child covered is diagnosed with, or undergoes surgery for, a critical illness that is covered and survives for at least 10 days.

The period of cover would typically start when the child is 30 days old and ends on their 18th birthday or 21st birthday depending if they are in full-time education.

Typically the lower of £25,000 or 50% of the cover amount for each child diagnosed with a critical illness. After the policy has paid out for a child, the policy will continue to cover you and any other children.


Source: 1

Cancer Research UK, February 2015.


Model ABI Critical Illness Definitions

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