Why This Matters
Heart attack is one of the most commonly claimed critical conditions — and one of the most frequently disputed. The 2019 ABI update to the heart attack definition was the most significant change in CI wording in a decade, and it created a clear divide between modern and legacy policies. If your client has a policy written before 2019, their definition of "heart attack" may be substantially narrower than today's standard — potentially costing them thousands in unpaid claims.
What Changed in 2019
The ABI Statement of Best Practice updated the model wording for heart attack to reflect advances in cardiac diagnostics. The key change: replacing enzyme-based diagnostic criteria with troponin-based criteria.
After 2019 (troponin-based): Evidence of myocardial infarction through elevated troponin levels (the modern gold standard) with symptoms of ischaemia. No minimum hospitalisation requirement.
Troponin testing is now the global standard for diagnosing heart attacks. It is more sensitive and specific than older enzyme tests. A patient can have a heart attack diagnosed via troponin testing that would have been missed entirely by older enzyme methods.
Three Scenarios Every Adviser Should Know
Scenario 1: The Gap Policy
Client took out a policy in 2015. They suffer a mild heart attack in 2026. Troponin levels are elevated and symptoms are present — but the 2015 policy requires "elevated cardiac enzymes with 24-hour hospitalisation." The client was discharged after 12 hours. Under the 2015 definition, the claim is declined. Under the current ABI standard, it would pay out.
Scenario 2: The Updated Policy
The same insurer may have updated their policy wording in 2020 to adopt the 2019 ABI standard. If your client has a "policy review" clause or has been moved to a newer product, their claim may succeed under the modern wording — even if the underlying condition is identical to Scenario 1.
Scenario 3: The Severity Model
Under a severity-based policy like Vitality SIC Plus, a heart attack that meets the troponin threshold but does not result in permanent damage may pay 25% of the sum assured. Under an all-or-nothing policy, the same event pays zero unless it meets the full definition. This is a crucial difference when advising clients on policy selection.
What to Look For in a Policy Document
When reviewing a client's existing CI policy, check for these specific phrases to determine if the definition is pre- or post-2019:
- "Elevated cardiac enzymes" — pre-2019 wording (outdated)
- "Elevated troponin" — post-2019 wording (current standard)
- "Minimum 24 hours hospitalisation" — pre-2019 requirement (often absent from modern policies)
- "Symptoms of myocardial ischaemia" — post-2019 wording
How CriticalIQ Helps
Use CriticalIQ's historical archive to pull the exact policy wording from your client's policy year. Compare it side-by-side against the current ABI standard and the provider's own modern wording. Generate a branded PDF showing the definition gap — this becomes the foundation of your advice letter or claim dispute.