How to Handle a CI Claim Dispute

A step-by-step guide to using CriticalIQ's historical archive to challenge a declined critical illness claim and secure the payout your client deserves.

Guide

5 steps to challenge a declined claim


Most declined CI claims are not "fraud" — they are failures of definition. The policy wording at the time of claim may not match the wording the client expected when they took out the policy. CriticalIQ helps you prove that gap.

1 Identify the policy year
Find the original policy document or schedule. Note the year the policy was taken out — this determines which definitions apply. A policy from 2015 will use pre-2019 ABI standards for heart attack and pre-2022 standards for cancer and stroke.
2 Look up the policy in the historical archive
Use CriticalIQ's historical archive to find the exact policy wording from the year your client took out cover. Search by provider name and year. The archive contains 640+ policies spanning 1985 to today, including legacy providers like Norwich Union, Friends Provident, and Scottish Equitable.
3 Compare the original definition to the current standard
Compare the original policy definition against today's ABI minimum standard. For example, a 2015 policy may define heart attack using outdated enzyme tests, while today's standard uses troponin testing. If the client meets today's standard but not the old one, the definition has changed — and that strengthens your dispute.
4 Document the gap in a compliance-ready PDF
Generate a CriticalIQ PDF report showing the definition gap. Include the original policy wording, the current best-practice wording, and the provider's own modern wording (if they have since updated). This becomes the core of your dispute letter.
5 Submit the dispute with evidence
Write to the insurer's claims team referencing the definition change. Attach the CriticalIQ PDF. Key arguments to make: (1) The definition has been updated since your client's policy was written; (2) Your client would have been paid under the current definition; (3) The FCA's Consumer Duty requires fair value — and an outdated definition may not represent fair value.
⚖️
Why this works
The FCA's Consumer Duty (2023) requires insurers to demonstrate fair value. An outdated definition that no longer reflects medical reality — and that the insurer itself has since abandoned — is a strong fairness argument. CriticalIQ gives you the documentary evidence to make that case.

Start building your case today

Access 640+ historical policies, compare definitions side-by-side, and generate compliance-ready PDFs — free for UK advisers.

Access the Archive →