Life & Critical Illness Blog

In Part 1 of our Critical Illness Definitions guide we looked at the ABI (Association of British Insurers) definitions for Alzeimers Disease, Aorta Graft Surgery, Benign brain tumour, blindness and cancer. Now we will look over a few more:-

Coma – resulting in permanent symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs which:

• requires the use of life support systems for a continuous period of at least 96 hours;

and

• results in permanent neurological deficit with persisting clinical symptoms.

For the above definition, the following is not covered:

• Coma secondary to alcohol or drug abuse.

Coronary artery by-pass grafts – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.

Deafness – permanent and irreversible

Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram.

Heart attack – of specified severity

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

• Typical clinical symptoms (for example, characteristic chest pain).
• New characteristic electrocardiographic changes.
• The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher;
- Troponin T > 1.0 ng/ml
- AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods.

The evidence must show a definite acute myocardial infarction.

For the above definition, the following are not covered:

• Other acute coronary syndromes including but not limited to angina.

Heart valve replacement or repair – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to replace or repair one or more heart valves.

HIV infection – caught (in the UK) from a blood transfusion, a physical assault or at work in an eligible occupation

Infection by Human Immunodeficiency Virus resulting from:

• a blood transfusion given as part of medical treatment;
• a physical assault; or
• an incident occurring during the course of performing normal duties of employment (from the eligible occupations listed below);1

after the start of the policy and satisfying all of the following:

• The incident must have been reported to appropriate authorities and have been investigated in accordance  with the established procedures.

after the start of the policy and satisfying all of the following:

• The incident must have been reported to appropriate authorities and have been investigated in accordance  with the established procedures.
• Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within 5 days of the incident.
• There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus.
• [The incident causing infection must have occurred in the UK] 2.

For the above definition, the following is not covered:
• HIV infection resulting from any other means, including sexual activity or drug abuse.
1Note: include specified occupations if applicable
2Note: include geographic limits as applicable