Let down by insurance policy fine print

Many people are at a loss when it comes to applying for a health and life insurance policy. A critical illness cover is no different. This type of insurance provides a single, lump sum payout should the insured become critically ill or injured as defined in the policy’s language.

But there is a catch: insurance companies do not just grant critical illness cover to any or everyone who applies.

Taking out a critical illness insurance might not be the most pleasing thing to go shopping for, but at least it’s practical, especially if your mortgage or business depends on you being fit enough to work.

The premise is that you’ll receive a payout from your insurer, depending on how much you pay them, for a diagnosis of a critical illnesses within six core areas: heart attack, kidney failure, major organ transplants, multiple sclerosis, stroke and cancer.

So imagine how you’d feel if you did get cancer, but your insurer said it didn’t count – which is what happened to Sally Wong.

In addition to being told she has cancer, Sally also found out she’s not going to receive any of the financial support she thought she’d paid for after being diagnosed with an early form of breast cancer called Ductal Carcinoma In Situ (DCIS).

This is when a non-malignant tumour has been found, which has the potential to become malignant and spread, but because it’s caught early it is still contained.

Sally took two critical illness policies out with an insurance company in 2001, costing RM500 a month and was diagnosed with DCIS in March 2006, and it was explained to her that her form of cancer, while still in the “in situ” phase, was also high-grade and therefore likely to become invasive. If this was allowed to happen, she would stand a low chance of survival.

She was given immediate surgery to remove the lump, followed by radiotherapy treatment to reduce the chance of the cancer spreading. An important factor in ensuring against this was to rest and recuperate. Fortunately, Sally had taken out a critical illness policy to protect her from having to work.

“When I was told I had in-situ again I thought to myself, ‘I can’t afford to have this – what’s my family going to do’? I felt desperate – I was told I needed months off work. You even end up thinking if it had invaded, at least I wouldn’t be a financial burden,” she added.

Because it had returned, they took no chances and removed the breast completely. However, complications with her skin healing following the mastectomy led Sally to need a further eight operations, leaving her physically unable to work.

“I feel that I’ve never fully gained my strength and can only do a fraction of what I could before I had my mastectomy. It’s a disabling amputation – one that leaves you totally incapacitated – but I’m never going to get any money.”