Review your Life Insurance policy

Life insurance

There has been a lot of media attention this week on the validity and strength of Comminsure life insurance policies with several case studies of people who have been declined claims based on what would appear to be valid claims on the surface.

It is concerning that people may be paying for life insurance policies that may not provide the coverage that they expected at claim time.

Whilst it may seem simple to select a life insurer to cover heart attack (via a critical illness policy), each insurer has different definitions for the events and conditions they cover under the category of heart attack.

To demonstrate this point, below we have provided the policy extracts from 5 major insurance companies on their coverage of heart attack including Comminsure.  As you can see, each has different methods to assess heart attack claims.

If you would like a free review of your life insurance policy, please contact us using the contact form on the right hand side, call us on 1300 88 18 18 or e-mail at info@financialadvisor.com.au

Please note: This information may be regarded as general advice. That is, your personal objectives, needs or financial situations were not taken into account when preparing this information.  Accordingly, you should consider the appropriateness of this information having regard to your own objectives, financial situation and needs before acting on it. Where the information relates to a particular financial product, you should obtain and consider the relevant product disclosure statement before making any decision to purchase that financial product.


Comminsure Protection Trauma Plus - Policy Extract

Heart Attack

Heart attack of specified severity: The death of part of the heart muscle (myocardium) as a result of inadequate blood supply. The diagnosis must be based on either: – the following medical evidence: * elevation of cardiac enzyme CK-MB or * elevation in levels of Troponin I greater than 2.0 mcg/L or Troponin T greater than 0.6 mcg/L or their equivalent and * confirmatory new electrocardiogram (ECG) changes or * medical evidence satisfactory to us that the heart attack reduced the Left Ventricular Ejection Fraction to below 50% when measured at least six weeks after the heart attack or – any other medical evidence satisfactory to us which demonstrates that myocardial damage has occurred to at least the same degree of severity as would be evidenced by the medical evidence required under the first bullet point.

MLC Insurance Critical Illness Plus - Policy Extract

Heart Attack: (Myocardial Infarction) means the death of part of the heart muscle because of inadequate blood supply, confirmed by a Cardiologist and evidenced by:

typical rise and/or fall of cardiac biomarkers with at least one value above the 99th percentile of the upper reference range together with either: •  new serial ECG changes showing the development of any one of the following: –  ST elevation –  left bundle branch block (LBBB), or –  pathological Q waves, or •  imaging evidence of new and irreversible: –  loss of viable myocardium, or –  regional wall motion abnormality. If the clinical pathway and disease management on hospital discharge for any medical event or investigation is not consistent with an acute myocardial infarction, then a claim is not payable under this policy. Myocardial infarctions arising from elective percutaneous procedures are excluded. If the above tests are inconclusive or superseded by technological advances, we’ll consider other appropriate and medically recognised tests.

TAL Accelerated Protection Critical Illness Premier - Policy Extract

Heart Attack (myocardial infarction) means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. The basis of diagnosis will be: – confirmatory new electrocardiogram (ECG) changes; and – a diagnostic rise and fall (other than as a result of cardiac or coronary intervention) in either Troponin I in excess of 2.0ug/L or Troponin T in excess of 0.6ug/L or cardiac enzyme CK-MB.

If the above criteria are not met, We will pay a claim based on satisfactory evidence that the Life Insured has unequivocally been diagnosed as having suffered a myocardial infarction resulting in: – a permanent reduction in the Left Ventricular Ejection Fraction to less than 50%, measured three months or more after the event; or – new pathological Q waves. At TAL’s discretion, We will also consider any other medical test result provided by a cardiologist that unequivocally diagnoses myocardial infarction of the degree of severity or greater as documented above. Minor Heart Attack means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. The basis of the diagnosis will be: – a confirmatory new electrocardiogram (ECG) changes; or – a diagnostic rise and/or fall of cardiac biomarkers with at least one reading above the 99th percentile of the upper reference limit. At our discretion, we will also consider any other medical test result provided by a cardiologist that unequivocally diagnoses myocardial infarction of the degree of severity documented above. If the clinical diagnosis and disease management on hospital discharge for any medical event or investigation is not consistent with an acute myocardial infarction as confirmed by a consultant cardiologist, then a claim is not payable under this policy. Myocardial infarctions arising from percutaneous procedures are excluded. In the case of Minor Heart Attack, the amount to be paid is reduced to 25% of the Benefit Amount to a maximum payment of $50,000. Only one payment can be made for Minor Heart Attack.

AMP Elevate Trauma Plus - Policy Extract

Heart Attack

Heart Attack means the death of an area of heart muscle due to lack of adequate blood supply where: > there are diagnostic changes in relevant cardiac enzymes or biomarkers in the days following the heart attack, and > there are typical new ischaemic changes in the electrocardiograph (ECG): new ST-T changes or new left bundle branch block (LBBB).

If the above criteria are not met, we will pay a claim based on satisfactory evidence that the person insured has unequivocally been diagnosed as having suffered a heart attack resulting in: > a permanent reduction in the Left Ventricular Ejection Fraction to less than 50 per cent measured in the three months or more after the event, or > new pathological Q waves.

Other acute coronary syndromes including, but not limited to, angina pectoris are excluded.

Heart Attack (Other) Early Payment

In the case of a Heart Attack (Other) Early Payment, we will pay you the lowest of: > 20 per cent of the Benefit, or > $100,000.

Heart Attack (Other) means the death of an area of heart muscle due to a lack of adequate blood supply where, together with symptoms of ischaemia there are diagnostic changes in relevant cardiac enzymes or biomarkers in the days following the heart attack.

A Heart Attack (Other) must be confirmed by diagnostic changes in relevant cardiac enzymes or biomarkers and there will be no need for typical new ischaemic changes (new ST-T) or new left bundle branch block (LBBB) in the electrocardiograph (ECG).

Excluded: > non heart attack related causes of elevated cardiac enzymes or biomarkers, and > other acute coronary syndromes including, but not limited to, angina pectoris.

AIA Priority Protection – Crisis

Heart Attack

‘HEART ATTACK’ (myocardial infarction) means the death of heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis must be confirmed by a cardiologist and evidenced by typical rise and/or fall of cardiac biomarker blood test (Troponin T, Troponin I or CK-MB) with at least one level above the 99th percentile of the upper reference limit PLUS: – acute cardiac symptoms and signs consistent with myocardial infarction (e.g. chest pain) OR – new serial ECG changes with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block (LBBB) OR – imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. If the above tests are inconclusive we will consider other appropriate and medically recognised tests. Other acute coronary syndromes including but not limited to angina pectoris are excluded

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