Critical Illnesses Covered

Critical Illness Cover Full definition

ABI model definition provided?

Alzheimer's Disease – resulting in permanent symptoms

A definite diagnosis of Alzheimer’s disease by a Consultant Neurologist, Psychiatrist or Geriatrician.
There must be permanent clinical loss of the ability to do all of the following:

• remember;
• reason; and
• perceive, understand, express and give effect to ideas.

For the above definition, the following are not covered:

• Other types of dementia

ABI model definition

Aorta Graft Surgery – requiring surgical replacement

The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches. For the above definition, the following are not covered:

• Any other surgical procedure, for example the insertion of stents or endovascular repair.

Exceeds ABI model definition

Aplastic Anaemia  – with permanent bone marrow failure

A definite diagnosis of Aplastic Anaemia by a Consultant Haematologist. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia

In addition to the ABI’s model list

Bacterial Meningitis – resulting in permanent symptoms

A definite diagnosis of Bacterial Meningitis resulting in permanent neurological deficit with persisting clinical symptoms.
For the above definition, the following are not covered:

• All other forms of meningitis other than those caused by bacterial infection

In addition to the ABI’s model list

Benign Brain Tumour – resulting in permanent symptoms

A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered:

• Tumours in the pituitary gland.
• Angiomas.   

ABI model definition

Blindness – permanent and irreversible

Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in the better eye using a Snellen eye chart.

ABI model definition

Cancer - excluding less advanced cases

Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, lymphoma and sarcoma. For the above definition, the following are not covered:

• All cancers which are histologically classified as any of the following:
• pre-malignant;
• non-invasive;
• cancer in situ;
• having either borderline malignancy; or
• having low malignant potential.
• All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.
• Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A.
• Any skin cancer other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin)

ABI model definition

Cardiomyopathy  – of specified severity

A definite diagnosis of cardiomyopathy by a Consultant Cardiologist. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classifications of functional capacity*.
For the above definition, the following are not covered:

• Cardiomyopathy secondary to alcohol or drug abuse.
• All other forms of heart disease, heart enlargement and myocarditis.

* NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

In addition to the ABI’s model list

Coma – resulting in permanent symptoms

A state of unconsciousness which:

• requires the use of life support systems; 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

Exceeds ABI model definition

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.

ABI model definition

Creutzfeldt-Jakob Disease (CJD) – resulting in permanent symptoms

A definite diagnosis of Creutzfeldt-Jakob disease made by a Consultant Neurologist. There must be permanent clinical loss of the ability in mental and social functioning to the extent that permanent supervision or assistance by a third party is required.

In addition to the ABI’s model list

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.

ABI model definition

Dementia – resulting in permanent symptoms

A definite diagnosis of Dementia by a Consultant Neurologist, Psychiatrist or Geriatrician. The diagnosis must be supported by evidence of progressive loss of ability to do all of the following:

• remember;
• to reason; and
• to perceive, understand, express and give effect to ideas

For the above definition, the following are not covered:

• Dementia secondary to alcohol or drug abuse.

In addition to the ABI’s model list

Encephalitis - resulting in permanent symptoms

A definite diagnosis of Encephalitis by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms.

In addition to the ABI’s model list

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:

• 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

Exceeds ABI model definition

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

ABI model definition

HIV infection – caught from a blood transfusion, physical assault or accident at work

Infection by Human Immunodeficiency Virus resulting from:

• a blood transfusion given as part of medical treatment in the European Union, the Channel Islands or the Isle of Man;
• a physical assault; or
• an incident occurring during the course of performing normal duties of employment;

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.

For the above definition, the following is not covered:

• HIV infection resulting from any other means, including sexual activity or drug abuse. 

ABI model definition

Kidney failure – requiring dialysis

Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary.

ABI model definition

Liver failure – of advanced stage

Liver failure due to cirrhosis and resulting in all of the following:

• permanent jaundice
• ascites
• encephalopathy

For the above definition, the following are not covered:

• Liver disease secondary to alcohol or drug abuse.

In addition to the ABI’s model list

Loss of hands or feet – permanent physical severance

Permanent physical severance of any combination of 2 or more hands or feet at or above the wrist or ankle joints.

ABI model definition

Loss of Speech - permanent and irreversible

Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

ABI model definition

Major Organ Transplant

The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver, lung, or pancreas, or inclusion on an official UK waiting list for such a procedure.
For the above definition, the following is not covered:
Transplant of any other organs, parts of organs, tissues or cells.

ABI model definition

Motor Neurone Disease  – resulting in permanent symptoms

A definite diagnosis of Motor Neurone Disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function.

ABI model definition

Multiple Sclerosis – with persisting symptoms

A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

ABI model definition

Paralysis of limbs –total and irreversible

Total and irreversible loss of muscle function to the whole of any 2 limbs.

ABI model definition

Parkinson's Disease – resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability.
For the above definition, the following is not covered:

• Parkinson’s disease secondary to drug abuse.

ABI model definition

Primary Pulmonary Hypertension  - of specified severity

A definite diagnosis of Primary Pulmonary Hypertension. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classifications of functional capacity*.
For the above definition, the following are not covered:

• Pulmonary Hypertension secondary to any other known cause i.e.not Primary.

* NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

In addition to the ABI’s model list

Progressive Supranuclear Palsy – resulting inpermanent symptoms

A definite diagnosis of Progressive Supranuclear Palsy by a Consultant Neurologist. There must be permanent clinical impairment of eye movements and motor function

In addition to the ABI’s model list

Respiratory failure – of advanced stage

Advanced stage emphysema or other chronic lung disease, resulting in all of the following:
The need for regular oxygen treatment on a permanent basis.

• The permanent impairment of lung function tests as follows;
  Forced Vital Capacity (FVC) and Forced Expiratory Volume at 1 second (FEV1) being less than 50% of normal.

In addition to the ABI’s model list

Stroke – resulting in permanent symptoms

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms.
For the above definition, the following are not covered:

• Transient ischaemic attack.
• Traumatic injury to brain tissue or blood vessels.                   

ABI model definition

Systemic Lupus Erythematosus – with severe complications

A definite diagnosis of Systemic Lupus Erythematosus by a Consultant Rheumatologist resulting in either of the following:

• Permanent neurological deficit with persisting clinical symptoms; or
• The permanent impairment of kidney function tests as follows;
  Glomerular Filtration Rate (GFR) below 30 ml/min.

In addition to the ABI’s model list

Terminal Illness

Advanced or rapidly progressing incurable illness where, in the opinions of an attending Consultant and our Chief Medical Officer, the life expectancy is no greater than 12 months For the above definition, the following is not covered:

• Terminal Illness as defined above during the last eighteen months of the policy

ABI model definition

Third Degree Burns – covering 20% of the body’s surface area

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body’s surface area.

ABI model definition

Total and Permanent Disability

Functional Assessment Tests Definition

If the Life Assured, immediately before the onset of disability, suffers through illness or accident, a mental or physical irreversible disability, which in the opinion of The Chief Medical Officer of Legal & General, results in the Life Assured being permanently unable to perform, without the direct assistance of another person, three or more of the following functions:
1) Walking:
The ability to walk a distance of 200 metres on flat ground with or without the aid of a walking stick and without stopping or experiencing discomfort.
2) Bending:
The ability to get into or out of a standard saloon car, and the ability to bend or kneel to pick up an object from the floor and straighten up again.
3) Communicating:
The ability to answer a telephone and to take a message.
4) Reading:
Having the required eyesight (corrected if necessary) to be able to read a daily newspaper.
5) Writing:
Having the physical ability to write legibly using a pen or a pencil without aid.
6) Climbing:
Having the ability to climb up a flight of 12 stairs without stopping or suffering severe discomfort.

Own Occupation Definition

If the Life Assured is engaged in a gainful occupation immediately before the onset of disability and is, by reason of sickness or accident, totally unable to follow his / her own occupation and in the opinion of Legal & General is likely to remain so permanently. Such decision will be based on all the medical evidence available. If in gainful employment the claim will be assessed on the occupation followed immediately before the onset of disability.

In addition to the ABI’s model list

Traumatic head injury - resulting in permanent symptoms

Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms.

ABI model definition