Critical illness - what's covered?
Legal & General’s critical illness product is designed to cover critical illnesses that could have a severe impact on your lifestyle. Critical illness cover would pay out if you were diagnosed with one of the specified illnesses and eligible to claim during the policy term.
Legal & General provide cover for 39 illnesses, the full list is detailed below. They offer an additional payout that does not affect your existing cover, under the 'mastectomy for ductal carcinoma in situ' definition*. This benefit is payable where the diagnosis results in total removal of a breast.
At no extra cost, critical illness cover is also provided for your children. There are some restrictions, further information can be found in the Key Features Document PDF.
What critical illnesses are covered?
Below you'll find the full list of critical illnesses covered. You'll also find information you need to know about this type of policy.
Alzheimer's disease - resulting in permanent symptoms
Aorta graft surgery - requiring surgical replacement
Aplastic anaemia - with permanent bone marrow failure
Bacterial meningitis - resulting in permanent symptoms
Benign brain tumour - resulting in either surgical removal or permanent symptoms
Blindness - permanent and irreversible
Cancer - excluding less advanced cases
Cardiomyopathy - of specified severity
Coma - resulting in permanent symptoms
Coronary artery by-pass grafts - with surgical thoracotomy
Creutzfeldt-jakob disease (CJD) - resulting in permanent symptoms
Deafness - permanent and irreversible
Dementia - resulting in permanent symptoms
Encephalitis - resulting in permanent symptoms
Heart attack - of specified severity
Heart valve replacement or repair - with surgical thoracotomy
HIV infection - caught from a blood transfusion, physical assault or accident at work
Kidney failure - requiring dialysis
Liver failure - of advanced stage
Loss of hand or foot - permanent physical severance
Loss of speech - permanent and irreversible
Major organ transplant
Mastectomy for ductal carcinoma in situ - requiring total removal of the breast
Motor neurone disease - resulting in permanent symptoms
Multiple sclerosis - with persisting symptoms
Multiple system atrophy - resulting in permanent symptoms
Open heart surgery - with median sternotomy
Paralysis of a limb - total and irreversible
Parkinson's disease - resulting in permanent symptoms
Primary pulmonary hypertension - of specified severity
Progressive supranuclear palsy - resulting in permanent symptoms
Removal of an eyeball - due to injury or disease
Respiratory failure - of advanced stage
Stroke - resulting in permanent symptoms
Systemic lupus erythematosus - with severe complications
Terminal illness
Third degree burns - covering 20% of the surface area of the body or 20% of the face or head
Total and permanent disability
Traumatic head injury - resulting in permanent symptoms
Are there any limitations and exclusions to the cover?
- The illnesses covered include cancer, heart attack and stroke but because of advances in medicine, not all occurrences of these illnesses are covered, as they will not always have a severe impact on your lifestyle. For example, a cancer needs to have spread or reached a specified severity to be covered under the policy. Similarly heart attacks that cause tissue damage are covered, but minor heart attacks that cause little tissue damage aren’t. In addition angina, which is a different type of illness, isn’t covered. Also, a stroke that results in permanent symptoms is covered, but if you only suffer temporary symptoms that disappear in a few days (sometimes called a mini-stroke) that isn’t covered.
- If you claim under critical illness cover, the benefit will only pay out if you are diagnosed with one of the specified critical illnesses listed on the policy during the period of cover and are eligible to claim. All illnesses covered by this policy are consistent with the current view of critical illness held by the medical profession and the Association of British Insurer's list of critical illnesses. 11 of our illnesses exceed the Association of British Insurers model definitions.
- Advances in medicine and technology mean that traditional views of critical illnesses are constantly changing. For example, not all types of cancer are covered by this insurance, because not all types of cancer have a severe impact on lifestyle if discovered and treated early enough.
- Above is a list of specified critical illnesses covered by our current policies. All must be verified by a medical specialist who is a consultant at a UK hospital, who is accepted by Legal & General's Medical Officer and whose specialism is appropriate to the cause of the claim.
- Please remember that the heading of each critical illness is only a guide to what is covered. Further details of how Legal & General will consider your claim, including the full definitions used and the evidence needed, are given in the policy terms and conditions, which will be sent to you when your policy starts.
- If you already have critical illness cover with Legal & General, please refer to your original policy document for full terms and conditions and definitions available to you. The illnesses you're already covered for may be different from those listed above. If you want to discuss this further or are unsure about what illnesses apply to you, please contact your financial adviser or Legal & General. You can call Legal & General on 0370 010 4080 between 8:30am and 6pm Monday to Friday and 9am to 1pm on Saturday. Call charges will vary. Calls may be monitored and recorded.
Total and Permanent Disability
- Total and Permanent Disability would allow you to claim under critical illness cover if you were to suffer from an illness, condition or accident that totally and permanently prevented you from working. A full assessment would be made to make sure that you met the full criteria and evidence would be required to demonstrate that you are too ill to ever work again.
- There are two definitions of total and permanent disability, own occupation and functional assessment tests (FATs).
- Occupation classes are categorised according to the type of work and the degree of stress involved. These are – 1,2,3,4 and Houseperson (i.e. not normally in paid employment such as a Houseperson, someone unemployed, a student or a retired person).
Please note that if you choose to add critical illness cover to your online life insurance application and you’re in occupation classes 3, 4 or Houseperson, you may be referred to the call centre at the end of the application process. This is because more information may be needed about your occupation before your application can be accepted.
Own occupation
If your occupation class is 1 or 2 and you apply online, you’ll be allocated the own occupation definition. This means that if you’re in a gainful occupation immediately before the onset of disability, the policy will pay out if, due to sickness or accident, you’re totally unable to follow your own occupation and in the opinion of our Medical Officer, are likely to remain so permanently. This decision would be based on all medical evidence available.
However, if you're not in gainful occupation at the time of a claim, then your claim will be assessed under the FATs definition.
You can choose the FATs definition at outset if you'd prefer to be assessed against the FATs criteria.
Functional assessment tests
This definition would apply to anyone in occupation classes 1 or 2 who didn’t choose the ‘own occupation’ definition, or any other occupation classes including Houseperson. The policy will pay out if due to illness or accident, you suffer an irreversible mental or physical disability, which in the opinion of our Medical Officer, results in you being permanently unable to carry out at least three of the following tests without the help of another person:
- Walking - The ability to walk a distance of 200 metres on flat ground with or without the aid of a walking stick and without stopping or experiencing discomfort.
- Bending - The ability to get into or out of a standard saloon car and the ability to bend or kneel to pick up an object from the floor and straighten up again.
- Climbing - the ability to climb up a flight of 12 stairs without stopping or suffering severe discomfort.
- Communicating - The ability to answer a telephone and take a message.
- Reading - Having the required eyesight (corrected if necessary) to be able to read a daily newspaper.
- Writing - Having the physical ability to write legibly using a pen or pencil without aid.
* Legal & General recognise the impact that a mastectomy can have on an individual and their lifestyle. They also recognise that when a successful mastecotomy does take place, people who’ve beaten this cancer go back to living their normal lives. And as life returns to normal, so does the need for protection. Critical illness cover provides an additional payout for mastectomy for ductal carcinoma in situ, which results in total removal of the breast. The amount payable is the lower of 25% of the sum assured, or £25,000. Only one claim per policy can be made, BUT the claim doesn’t affect the full sum assured or premium. Details can be found in the Key Features Document PDF.
