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. Model ABI Critical Illness Definitions include:

The pulmonary artery is the artery that provides a blood supply to the lungs. This may become damaged or diseased and therefore require surgery to repair.

Rheumatoid arthritis is a disease of the immune system which causes chronic inflammation of the joints, tissues around the joints and other organs of the body.

Crohn’s disease is an inflammatory disease which can involve both the large and small intestines, but can also affect other parts of the digestive system. In more severe cases, this can lead to ulcers and narrowing of the bowel. Symptoms include abdominal pain, diarrhoea and vomiting.

Lung disease is any disease or disorder that occurs in the lungs or causes the lungs not to work properly. To be classed as severe there must have been the need for continuous daily oxygen therapy for a minimum of 6 months, a vital capacity of less than 50% of normal and FEV1 being less than 40% of normal. These are tests of your ability to breathe properly.

A stroke is where the blood supply to the brain is interrupted which causes the sudden death of some brain cells. This is usually caused by a blockage or rupture of an artery to the brain. Another term for stroke is cerebrovascular episode or accident (CVA).

Structural heart surgery is the undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist, to correct any structural abnormality of the heart. 

The surgical division of the breastbone and the opening up of the chest wall, for the purpose of correcting a structural abnormality of the heart, for example, the surgical correction of a ventricular septal defect.

Systemic lupus erythematosus  – The body’s immune system produces white blood cells and proteins called antibodies to destroy viruses and bacteria that are foreign to the body. Lupus, like other auto-immune diseases, mistakes your own tissue as foreign and attacks it causing inflammation. It can affect major organs in the body and stop them functioning properly.

A definite diagnosis by the attending Consultant of an illness that satisfies both of the following:

The illness either has no known cure or has progressed to the point where it cannot be cured; and

In the opinion of the attending Consultant, the illness is expected to lead to death within [the earlier of] 12 months [and the remaining term of the cover].

Third Degree Burns involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the bodies surface area or 50% loss of surface area of the face which for the purpose of this definition includes the forehead and ears.

Third degree burns are the most serious type of burn. They involve the destruction of the full thickness of the skin and can cause damage to the fat, muscle and bone beneath.

Traumatic head injury is  the death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms.

Damage to the brain tissue could be caused by an external trauma such as a severe head injury received in a road traffic accident.