AIG Life has formally confirmed that its underwriting and claims payment approach has not changed after adopting Association of British Insurers (ABI) minimum wordings requirement for its heart attack definition on critical illness policies.
As a result, product review system CIExpert has withdrawn its concerns that the changes would mean claims could be declined and has confirmed that AIG Life’s scores will not be affected.
At the start of the month, AIG made adjustments to its critical illness cover to meet the 31 January deadline for replicating or enhancing the ABI’s minimum wordings requirement.
AIG’s new definition which Health & Protection has seen states:
“Heart attack – of specified severity.
“A definite diagnosis of acute myocardial infection with death of heart muscle, as evidence by all of the following: – typical clinical symptoms (for example, characteristic chest pain), new characteristic electrocardiographic changes or new diagnostic imaging changes, and the characteristic rise of cardiac enzymes or Troponins.”
The previous definition which Health & Protection has also seen made no reference to “typical clinical symptoms”.
One in five heart attacks silent
Releasing its verdict on the changes at the time, CIExpert said it was “disappointing to note that the heart attack definition has been weakened by the insistence on showing ‘typical clinical symptoms’.”
CIExpert director Alan Lakey told Health & Protection the issue he raised with AIG Life was the revised definition insisted on three claims triggers, one of which is new. This new trigger insists on typical clinical symptoms, such as chest pain, which was not part of the previous definition.
Lakey revealed that 22% of all heart attacks are ‘silent’ without chest or arm pain and his consultant epidemiologist confirmed the revised wording enabled AIG Life to decline a claim if there was not any chest or arm pain.
Consequently, Lakey sought assurances this was not the case.
Claims will not be declined
Yesterday, Lakey told Health & Protection that AIG Life had confirmed it would not decline a claim because the claimant did not display “typical clinical symptoms“.
He added the clarification ensured that the insurer’s scores on the CIExpert system will not now be affected.
Lakey explained that CIExpert provides each definition with a score for every age 18 to 85, so the total for a plan over 25 years is the total of each of those individual ages – adjusted for gender and smoker status.
“The score for AIG’s heart attack definition would’ve been reduced to remove the ’silent heart attack’ figures,” he added.
Health & Protection contacted AIG Life for comment on the changes.
In a statement the insurer said: “We recently updated the wording of some CI definitions in our critical illness insurance customer literature.
“This included new wording on our heart attack definition to clarify for customers when we pay a claim, though our claims philosophy remains unchanged.”
A number of other CI definition changes were also made earlier this month, including:
- a clarification that myocardial injury without myocardial infarction (heart attack) is excluded;
- on cancer that as well as including less advanced cancer of the prostate that is treated by prostatectomy, the scope of the claim has been widened by the specific inclusion of Merkel Cell carcinoma, cutaneous angiosarcoma plus some sarcomas and lymphomas;
- and on dementia – a clarification that mild cognitive impairment is not included.
