Making Insurance Claims After a Diagnosis in the UK

People often have more insurance cover than they realise — including policies arranged through an employer or taken out years ago. After a serious diagnosis, checking every possible source of cover is one of the most important practical steps you can take. This guide explains what to look for, how claims work, and what to do if a claim is refused. If you'd rather have a plan built around your situation, answer a few questions and we'll build one around you →

Types of policy to check

Do not cancel or change any policy while you're working out what you hold. Some policies pay out on diagnosis alone, and cancelling now could forfeit an entitlement. Check everything first, then decide what to do.

• Life insurance — pays a lump sum to your beneficiaries on death. While not a direct benefit to you while alive, many life insurance policies include a terminal illness benefit: if a doctor certifies that your life expectancy is less than 12 months, the policy pays the death benefit to you early, while you are still alive. Check your policy documents or call your insurer to ask whether this clause exists and what the threshold is.
• Critical illness cover — pays a lump sum on diagnosis of a listed condition, regardless of whether you can continue working. Commonly covered conditions include cancer, heart attack, stroke, coronary artery bypass surgery, kidney failure, and major organ transplant, though the exact list and definitions vary significantly between policies. The payment is tax-free.
• Income protection insurance — replaces a portion of your pre-illness income (typically 50–70%) while illness or injury prevents you from working. The amount, waiting period before payments begin, and how long payments last all depend on your specific policy.
• Mortgage Payment Protection Insurance (MPPI) — covers your mortgage repayments for a defined period while you're unable to work due to illness, injury, or in some cases redundancy. Check your policy for the waiting period, the maximum monthly benefit, and how long payments can last.
• Private Medical Insurance (PMI) — covers the cost of private healthcare including consultations, diagnostics, and treatment. PMI does not usually pay a cash sum, but it can enable faster access to specialist care and a wider choice of consultant and hospital. Check what your policy covers for your specific diagnosis — in particular whether it covers outpatient treatment, cancer drugs not routinely available on the NHS, and long-term follow-up care.

Group schemes through your employer

Employer-provided group insurance is easily overlooked because the employer typically arranges it and pays the premium — it may not appear prominently in your pay documents. Check your employment contract and staff handbook, or ask your HR department, about the following:

• Group life assurance (death in service) — the most common employer-provided benefit. Pays a lump sum — often two to four times your annual salary — to your nominated beneficiaries if you die while employed. Some schemes also include a terminal illness element that pays out early. Check your scheme rules and make sure your nominated beneficiary details are up to date.
• Group income protection — an employer-arranged scheme that pays a portion of your salary (typically 50–75%) if you are off sick long-term, usually after your employer's own sick pay ends. It is administered by the insurer but arranged by the employer; your HR team can confirm whether you are covered and how to claim.
• Group critical illness cover — less common than life assurance or income protection but offered by some employers. Pays a lump sum on diagnosis of a qualifying condition, similar to a standalone critical illness policy.
• Group private medical insurance — many employers provide PMI as a benefit. If yours does, your HR team can confirm what the policy covers and how to access it. Treatment under a group PMI scheme typically works the same way as a standalone policy.

If you have left a previous employer in the past few years, ask whether their group scheme offered a continuation option — a right to convert group cover into a personal policy without further underwriting when you left employment. If you exercised this option, you may hold a standalone policy you've lost track of.

Finding forgotten or lost policies

Cover from earlier in your life — a policy taken out with a previous employer, a mortgage lender, or a financial adviser — can easily be lost track of. Here is where to look:

• Old bank statements — search for regular direct debit payments to insurance companies. A premium as small as a few pounds a month may represent cover you've forgotten about. Bank statements go back further online than you might expect; many banks provide seven years or more via their app or online banking.
• Old payslips and employment records — check for any deductions labelled as insurance, protection, or benefit contributions. Contact the HR departments of previous employers to ask what group schemes were in place and whether you were covered.
• Email and paper files — search for policy documents, annual renewal letters, and correspondence from insurance companies. Insurers are required to send annual statements for protection products.
• The Unclaimed Assets Register — unclaimedassets.co.uk. A tracing service for forgotten financial products including life insurance policies and pension plans. There is a small fee to use it.
• The Association of British Insurers (ABI) tracing service — the ABI provides a free life insurance tracing service for people trying to locate a policy held by themselves or a deceased person. Use the online form at abi.org.uk.
• GOV.UK pension tracing service — gov.uk/find-pension-contact-details. Helps you find the contact details for a workplace or personal pension. Worth using if you've had multiple employers, as group life assurance and income protection are often arranged through or alongside the employer's pension scheme.
• Previous financial advisers or brokers — if you have used a financial adviser or insurance broker at any point, they may hold records of policies arranged on your behalf. Contact them directly.
• Mortgage documents — some lenders attach life insurance or MPPI as a condition of, or alongside, a mortgage offer. Check your original mortgage paperwork or contact your lender to ask whether a policy was arranged at the time.

Critical illness cover — how definition matching works

Critical illness cover is more specific than it appears. Receiving a diagnosis of a condition listed in your policy is not automatically enough to trigger a claim — the diagnosis must match the policy's own definition of that condition. These definitions are precise, and they vary between insurers and between policy generations.

Common points where definitions matter:

• Cancer — most policies exclude certain early-stage or non-invasive cancers. Definitions commonly exclude carcinoma in situ (cancer that has not yet invaded surrounding tissue), basal cell carcinoma of the skin, and some forms of very early-stage prostate cancer below a defined PSA threshold or Gleason score. Read your policy's cancer definition carefully, and ask your oncologist whether your diagnosis falls within or outside it.
• Heart attack — definitions typically require documented evidence of myocardial damage: a rise and fall in cardiac biomarkers (such as troponin) to above a defined threshold, plus either symptoms of ischaemia or new ECG changes. A clinical diagnosis of heart attack by your cardiologist, without the specific test results in the format the policy requires, can sometimes cause complications at claim stage.
• Stroke — most policies require that the stroke produces a neurological deficit lasting longer than 24 hours, distinguishing it from a transient ischaemic attack (TIA). Imaging evidence is usually required.
• Survival period — some older policies contain a survival clause requiring you to survive for a specified period (commonly 14 or 28 days) after the qualifying event before the benefit is payable. Check whether your policy includes this clause.

To give a claim the best chance:

• Read the relevant definition in your policy document before notifying the insurer — understand exactly what the criteria are and how your diagnosis sits against them.
• Ask your specialist to provide a written report that explicitly references the clinical criteria used: diagnostic test results, staging, pathology findings, and any relevant codes or grading. A letter that simply states the condition name without clinical detail may not be sufficient.
• Notify the insurer promptly — most policies require notification within a specified period of diagnosis, and delay can complicate the claim.

Income protection — understanding the definitions

Income protection policies use one of three definitions to determine whether you qualify for benefit, and the definition in your policy makes a substantial difference to your chances of a successful claim:

• Own occupation — you qualify if you are unable to perform the material duties of your specific occupation at the time of your claim, taking into account your training, education, and experience. This is the most generous definition and is most likely to pay out for people with specialist or professional roles where a condition prevents them doing their specific job even if they could theoretically do other work.
• Suited occupation (sometimes called "suited to by training and experience") — you qualify if you are unable to perform the duties of any occupation reasonably suited to your skills, qualifications, and experience. More restrictive than own occupation — the insurer may argue that you could do a different, related job even if you cannot do your current one.
• Any occupation (sometimes called "any work") — you qualify only if you cannot perform any paid work at all. The most restrictive definition; it rarely pays out except for severe conditions that prevent all forms of employment.

Also check:

• Deferred (waiting) period — the period between becoming unable to work and when payments begin. Common periods are one, three, six, or twelve months. Your policy will not pay during this time; coordinate with your employer sick pay and SSP to ensure there is no gap.
• Benefit period — how long payments continue. Some policies pay until you return to work or reach a set retirement age (65 or 70); others pay for a defined maximum period of two or five years. Check which applies to yours.
• Index-linking — some policies increase the benefit each year in line with inflation. This matters significantly for long-term claims.
• Proportionate benefit — some newer policies pay a partial benefit if you return to work part-time or in a reduced capacity, rather than stopping entirely when you go back at all.

How to make a claim

The process is broadly similar across policy types. Do not wait until you have gathered all your documents before contacting the insurer — notify them as soon as you decide to claim, then gather what's needed.

• Notify the insurer promptly. Call or write to your insurer to register your intention to claim. Note the date, the name of the person you spoke to, and any reference number given. Most policies include a notification requirement — late notification can complicate your claim even if the underlying claim is valid.
• Request a claim form. The insurer will send you (or make available online) a claims pack with a form and a list of required documents. Read the requirements carefully before gathering anything.
• Obtain a written medical report from your GP or specialist. The report should include the diagnosis (using clinical terminology), date of diagnosis, diagnostic test results and findings relevant to the policy definition, current treatment, and prognosis. A vague letter confirming a condition name may not satisfy the insurer's requirements.
• Gather supporting documentation. Depending on the policy type, this may include: completed claim form; medical reports; test results or pathology reports; proof of income or pre-illness earnings (for income protection); copies of employment contracts if a group scheme is involved.
• Submit and keep copies of everything. Record the date you submitted the claim and obtain written confirmation of receipt. Keep a copy of every document you send — insurers can lose submissions, and having a copy prevents delays.
• The insurer will contact your doctor. You will be asked to sign an authority allowing the insurer to contact your GP or specialist directly. This is standard practice; the insurer uses it to verify the medical information in your claim. They may also request access to your wider medical history.
• Independent Medical Examination (IME). For significant claims, particularly income protection and critical illness, the insurer may ask you to attend an examination by a doctor of their choosing. You are generally required to cooperate with a reasonable request; declining can lead to your claim being suspended. You are entitled to ask for a report of the IME findings.

How UK insurance is regulated

Insurance in the UK is regulated by two bodies, both of which have a role in protecting policyholders:

• Financial Conduct Authority (FCA) — regulates the conduct of insurers and insurance intermediaries (brokers, financial advisers). FCA rules require insurers to handle claims promptly and fairly, treat customers as individuals rather than applying blanket policies, and not reject claims unreasonably. The FCA's Insurance Conduct of Business Sourcebook (ICOBS) sets specific obligations on claims handling. You can verify any insurer or adviser is FCA-authorised at register.fca.org.uk.
• Prudential Regulation Authority (PRA) — part of the Bank of England, the PRA regulates the financial soundness and stability of insurers to ensure they hold sufficient reserves to pay claims. An insurer that is PRA-regulated has been assessed as financially capable of meeting its obligations.

If you believe an insurer is not complying with FCA rules in how they're handling your claim — for example by unreasonably delaying a decision, requesting unnecessary information, or applying policy terms in a way that breaches fair treatment obligations — you can report this to the FCA at fca.org.uk/consumers/complaints-against-us, although the FCA does not resolve individual disputes. Individual complaints are handled by the Financial Ombudsman Service (see below).

If your claim is declined

A declined claim is not final. You have a clear, free escalation path — and insurers know that the Financial Ombudsman Service frequently overturns declined claims.

Step 1 — Internal complaints procedure

Before going elsewhere, you must first make a formal complaint through the insurer's internal complaints process. Write to the insurer setting out clearly why you believe the decision was wrong, referencing the relevant policy definition and the medical evidence. Ask for all documents and information the insurer relied upon in reaching their decision — they are required to provide this.

Under FCA rules, the insurer must send you a final response letter within eight weeks of receiving your complaint. The final response must either resolve your complaint or explain why they maintain their position. Keep this letter — it is the trigger for the next step.

Step 2 — Financial Ombudsman Service (FOS)

If the internal process does not resolve your complaint, you can escalate to the Financial Ombudsman Service (FOS) — a free, independent statutory body with the power to make binding decisions on insurers.

FOS covers all FCA-regulated insurance, including life insurance, critical illness cover, income protection, MPPI, and PMI. FOS caseworkers review the insurer's decision impartially and can direct the insurer to pay a claim, pay redress, or take other action. FOS decisions are binding on the insurer if you accept them; if you don't agree with the FOS decision, you remain free to pursue the matter through the courts instead.

• Website: financial-ombudsman.org.uk
• Phone: 0800 023 4567 (free)
• Time limit: you must contact FOS within six months of receiving the insurer's final response letter. Do not miss this deadline — FOS cannot usually investigate complaints brought outside the time limit without exceptional circumstances.

For large or complex disputed claims, it is also worth consulting a solicitor who specialises in insurance law. Many work on a conditional fee (no win, no fee) basis for insurance disputes. An independent solicitor can advise on whether your case is worth pursuing through FOS or through the courts, and can help you frame the legal arguments.

No no-fault personal injury scheme in the UK

New Zealand has the Accident Compensation Corporation (ACC), a no-fault scheme that compensates all injury regardless of cause. The UK has no equivalent. If you are ill — rather than injured at work — the main sources of financial support are personal insurance, NHS treatment (free), and the state benefit system.

Two exceptions are worth knowing about:

• Employers' liability and work-caused conditions — if your illness was caused or significantly worsened by your work — for example, lung disease from asbestos exposure (mesothelioma, asbestosis), occupational deafness, vibration white finger, or certain occupational cancers — you may have a claim against your employer under employers' liability law. Employers are legally required to hold employers' liability insurance. This is a civil claim pursued through a solicitor, not an automatic entitlement. Contact a solicitor specialising in occupational disease — many work on a no win, no fee basis. The Trades Union Congress (TUC) and individual trade unions can also provide guidance for their members.
• Industrial Injuries Disablement Benefit (IIDB) — a state benefit administered by DWP for people whose disability was caused by an accident at work or by one of a list of prescribed industrial diseases. IIDB is separate from personal insurance claims and is assessed based on the degree of disablement. It does not cover general illness; it covers specific industrial diseases (such as pneumoconiosis, asbestosis, mesothelioma, occupational deafness, and occupational asthma). Check the full list at gov.uk/industrial-injuries-disablement-benefit.

For illness that is not work-related, NHS treatment is free, and state benefits (Universal Credit, ESA, PIP) provide income and disability support. Personal insurance remains the main financial protection above the state floor.

Getting help with a claim

Insurance policy wording is technical, definitions are interpreted strictly, and the medical evidence requirements can be exacting. If you are unsure whether your diagnosis meets a policy definition, are dealing with a complex claim, or have had a claim declined, consider getting professional help before accepting the insurer's decision as final.

• Macmillan Cancer Support — 0808 808 00 00. Macmillan has a specialist benefits and financial guidance team that can help people with cancer understand insurance entitlements and navigate claim processes. They do not provide regulated financial advice but can help you identify what to look for and who else to contact.
• Citizens Advice — citizensadvice.org.uk. Free advice on insurance rights, how to complain, and next steps if a claim has been declined. Can help you draft a complaint letter and understand the FOS process.
• A regulated financial adviser — an adviser who specialises in protection insurance can help interpret policy definitions, prepare evidence for a claim, and correspond with the insurer on your behalf. Verify any adviser is FCA-authorised at register.fca.org.uk before engaging them. Advisers must not charge you for advice that results in a claim on your own existing policy — check their fee terms upfront.
• A solicitor specialising in insurance disputes — for declined claims involving significant sums, a specialist insurance solicitor can advise on the legal merits and represent you at FOS or in court. Many work on a conditional fee basis for insurance matters. Ask Citizens Advice or the Law Society (solicitors.lawsociety.org.uk) for a referral.