Bright Grey has bemoaned the ambiguity in the critical illness (CI) claims process after revealing a sixth of claims were declined due to the definition not being met last year.
The protection specialist says entirely illegitimate claims can still count among firms' statistics depending on their process.
It paid 83% of CI claims between 1 April 2008 and 31 March 2009, but only 1.8% of the declined cases came about as a result of non-disclosure, leaving 15.2% turned down due to the definition not being met.
"It's difficult," Bright Grey proposition director Roger Edwards says. "When does a claim become a claim?
"We'll have people claiming for Total and Permanent Disability (TPD) on a broken ankle. That counts as a claim. There will always be some [illnesses] that don't meet the definition."
Bright Grey says it paid £20m in CI claims in the last financial year, pointing out its claims declined for non-disclosure slumped from 12% in 2007/8 to 1.8% in the latest figures.
The average age of CI claimants was 43 for men and 39 for women and 70% of claims were for cancer.
"We're making real progress, paying more claims and driving down the number of claims that are declined due to non-disclosure," Edwards adds.
"Non-disclosure has been an issue that has concerned the industry for a long time, but our figures provide a reassurance our plan owners can be confident claims will be paid."IFAonline
'Necessary steps' taken
Penalty payments and enforcement policy
Fees as low as 0.04%
Client procurement costs ‘unsustainable’
Only 9,486 applied for the benefit in 12 months