Critical Illness Cover

Critical Illnesses Covered

Critical Illness Cover Full definition

What Does This Mean ?

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.
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.

Alzheimer’s disease is a condition which affects the brain. Symptoms include memory loss, confusion,
communication problems and general impairment of mental function. The condition gradually worsens, which can lead to changes in personality and makes routine tasks difficult. Eventually, 24 hour care may be needed.

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.

The aorta is the body’s main artery carrying blood from the heart. This definition covers surgery to the aorta, where part of it is removed and replaced with a graft. Surgery may be needed to correct a weakening or bulging in the artery. It covers only the aorta, which is the main blood vessel in the chest and abdomen. This definition doesn’t cover the branches of the aorta.
We cover surgery for traumatic injury, as well as the ABI standard of surgery
following disease.

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.

Aplastic anaemia is a rare but serious condition where bone
marrow fails to produce sufficient blood cells or clotting agents. Symptoms include shortness of breath, excessive bleeding and an increased chance of catching infections.
It can be life-threatening if left untreated.

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.

Bacterial meningitis causes inflammation to the meninges,
which is the protective layer around the brain and spinal cord. It’s caused by a bacterial infection and needs prompt medical treatment. Initial symptoms include headache, fever and vomiting. If left untreated, it can result in brain damage or death.
Some people will recover completely, while others will be left with permanent symptoms, which may affect their mobility or use of senses. This definition only covers people left with permanent symptoms.
This definition covers the bacterial form of meningitis.
It excludes all other forms of meningitis – like viral meningitis, which is usually milder.

Benign Brain Tumour - resulting in either surgical removal or permanent symptoms

A non-malignant tumour or cyst in the
brain, cranial nerves or meninges within
the skull, resulting in either surgical
removal or permanent neurological
deficit with persisting clinical symptoms*.
For the above definition, the following are
not covered:
• Tumours in the pituitary gland.
• Angiomas.
BENIGN BRAIN TUMOUR – resulting in either surgical removal or permanent symptoms 

A benign brain tumour is a non-cancerous abnormal growth of tissue that can increase in size and cause pressure in the brain. Symptoms may vary depending on where the tumour is but may include headaches, seizures and blurred vision.
Surgery to remove the tumour might be possible and once
removed they tend not to recur.
However, surgery isn’t always an option due to the size or
location of the tumour.
This definition covers surgical removal of a tumour (whether
permanent neurological symptoms persist or not) and tumours where surgery has not been performed but which result in permanent neurological symptoms.
This definition doesn’t cover tumours in the pituitary gland (a small gland within the brain) and angiomas (a benign tumour of blood vessels).

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.

This means permanent loss of vision. It’s measured with a
Snellen eye chart: the chart commonly used by opticians,
which consists of a gradually decreasing series of letters and
numbers. 3/60 vision means you can read a letter at three metres that can normally be read at 60 metres. To claim, your vision must be 3/60 or worse in your better eye.
This definition doesn’t cover temporary blindness

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).

Cancer (also known as a malignant tumour) is a disease where normal cells change and grow in an abnormal way. If left untreated, they can destroy
surrounding healthy cells and eventually destroy healthy cells in other parts of the body.
There are about 200 different types of cancer, varying widely in outlook and treatment.
Some cancers are not covered by this definition. These tend to be ones that have not yet spread or are localised and can usually be successfully treated.
Examples of these include some skin cancers and early stage prostate cancer.

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 classification’s 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.

Cardiomyopathy is the name given to a group of disorders affecting the muscles of the heart that affect its function. Symptoms vary depending on the type of Cardiomyopathy, but may include shortness of breath, fainting and palpitations.
The New York Heart Association (NYHA) functional classification system is commonly used in the UK to assess heart function. The system relates symptoms to everyday activities and the patient’s quality of life.
NYHA Class 3 is ‘Marked limitation of physical activity. Comfortable at rest, but less than ordinary
activity causes fatigue, palpitation or dyspnoea.’
(Source: Heart Failure Society of America, 2007).
Note: Dyspnoea is difficulty in breathing.

Coma – resulting in permanent symptoms

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

A coma is a state of unconsciousness from which the
patient cannot be aroused and has no control over bodily functions. It may be caused by illness, stroke,
infection, very low blood sugar or serious accident.
Recovery rates vary, depending upon the depth and duration of the coma.
While the ABI define a coma as lasting ‘at least 96 hours’, we don’t set a time limit. Our definition does not require the use of life support systems.

Coronary Artery By-Pass Grafts – with surgical thoracotomy

The undergoing of surgery requiring
anterolateral thoracotomy on the advice
of a Consultant Cardiologist to correct
narrowing or blockage of one or more
coronary arteries with by-pass grafts.
For the above definition, the following are
not covered:
• balloon angioplasty;
• atherectomy;
• rotablation;
• insertion of stents; and
• laser treatment.

Coronary arteries can become narrowed or blocked by the build up of fatty deposits caused by poor lifestyle such as high fat diet, smoking and high blood pressure. This may cause symptoms including chest pain and can sometimes cause a heart attack. Coronary artery by-pass surgery is used to treat blocked arteries in the heart by diverting the blood supply around the blocked artery using a vein, usually taken from the leg, arm or chest.
This definition covers surgery if it requires the heart to be reached by a surgical incision through the chest wall or sternum (breastbone), to replace the blocked arteries with a vein. This definition doesn’t cover other surgical procedures to treat blocked arteries such as balloon angioplasty or insertion of stents.

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.

Creutzfeldt-Jakob disease (CJD) is a rare disease of the nervous
system. CJD can be present without symptoms for many years.
Once they appear, symptoms may include failing memory, problems with vision, immobility, loss of speech and coma in advanced stages. There is currently no known cure.

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.

This means permanent loss of hearing in both ears, measured by using an audiogram across different frequencies, which vary from low to high pitch. The
hearing loss must be across all frequencies. This definition doesn’t cover partial loss of hearing.

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.

Dementia is a term used to describe various different brain disorders that have in common a loss of brain function.
Symptoms may include memory loss, confusion and the inability to reason. Dementia is usually progressive and eventually severe. It causes the sufferer to become confused and disorientated and often unable to perform routine tasks like cooking a meal.

Encephalitis - resulting in permanent symptoms

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

Encephalitis is inflammation of brain tissue. It is usually caused by an infection. Symptoms might include severe headache, nausea,
vomiting, convulsions, personality changes, problems with speech and/or hearing, confusion and disorientation. Encephalitis can range in severity from relatively mild to life threatening.

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

A heart attack, also known as a myocardial infarction, happens when part of the heart muscle
dies because it has been starved of oxygen. This causes severe pain and an increase in cardiac
enzymes and Troponins, which are released into the blood stream from the damaged heart muscle.
Our definition doesn’t include the words ‘typical clinical symptoms (for example, characteristic chest
pain)’ as in the ABI’s ‘Heart attack’ definition. This is because other tests can prove that a heart attack has taken place and it’s possible to have a heart attack without common symptoms such as chest pain.
This definition doesn’t cover angina or any other heart condition.

Heart Valve Replacement or Repair – with surgical thoracotomy

The undergoing of surgery requiring
anterolateral thoracotomy on the advice
of a Consultant Cardiologist to replace or
repair one or more heart valves.

Healthy heart valves are important to make sure blood flows through the heart in the right direction so that blood is circulated
around the body efficiently. There are various causes of heart valve disease including birth defects, rheumatic fever, age and other heart related conditions such as cardiomyopathy. Symptoms of heart valve disease include breathlessness, chest pain, swelling of the ankles and legs and fainting. This definition covers surgery to a heart valve if it requires open heart surgery, reached by a surgical incision through the chest wall or sternum (breastbone).
This definition doesn’t cover surgical procedures that don’t
involve open heart surgery.

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;
• 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.
• The incident causing infection must have occurred in one of the following countries: Australia, Austria, Belgium, Bulgaria,
Canada, the Channel Islands, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, the Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Norway, Poland, Portugal,
Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the United States of America.
For the above definition, the following is not covered:
• HIV infection resulting from any other means, including sexual activity or drug abuse.

This definition covers HIV infection from a blood transfusion, physical assault or when caught at work.
HIV can lead to the development of Acquired Immune Deficiency Syndrome (AIDS). This is when the body’s immune system breaks down, increasing the risk of infections and tumours. Although
there are treatments for AIDS and HIV to slow down the virus’s progression, there is currently no known cure.
When HIV is caught during an
incident at work, our definition includes all occupations with established reporting procedures.
This definition doesn’t cover HIV
infection through other means, including sexual activity or drug abuse.

Kidney failure – requiring dialysis

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

The kidneys perform an important role filtering the body’s waste to pass as urine. If the kidneys
fail, there is a harmful build up of the body’s waste products. In severe cases it may be necessary for the filtering to be done by a dialysis machine or, in some cases, a transplant may be needed. Kidney failure can become life threatening. This definition covers kidney failure that requires dialysis.

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.

The liver is an important organ, which carries out several of the body’s vital functions such as helping with digestion and clearing toxins. This definition covers liver failure at an advanced stage.
This type of liver failure must lead to permanent jaundice (yellow discolouration of the skin),
ascites (build up of fluid in the abdomen), and encephalopathy (brain disease or damage).
This definition doesn’t cover liver disease that’s secondary to alcohol or drug abuse.

Loss of hands or feet – permanent physical severance

Permanent physical severance of a hand or foot at or above the wrist or ankle joints.

This means physical severance and may be caused by illness or serious accident. This definition only requires severance of either a hand or foot above the wrist or ankle joints.

Loss of Speech - permanent and irreversible

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

This is when you won’t be able to talk again. It’s often caused when the vocal cords need to be removed because of a tumour or a serious injury.
This definition doesn’t cover temporary loss of speech.

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.

Occasionally, an organ may become so diseased that it needs to be replaced.
You will be covered as soon as you are put on the official UK waiting list because it may take a long time to find a donor.
This definition doesn’t cover donating an organ.

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.

Motor neurone disease (MND) is a gradual weakening and wasting of the muscles, usually beginning in the arms and legs. This may cause difficulty walking or holding objects.
As the disease develops, other muscle groups may be affected,
such as those involving speech, swallowing and breathing.
Eventually, 24 hour care may be needed.
The progression rate of MND varies between individual sufferers. An effective treatment has yet to be discovered.

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 six months.

Multiple sclerosis (MS) is the most common disabling neurological disease among young adults and is usually diagnosed between the ages of 20 and 40.
Symptoms may be slight, particularly in the early stages.
Symptoms may include changes in vision, altered sensation, loss of muscle strength and lack of coordination. To claim, the
symptoms need to occur continuously for six months or more.
There’s no known cure and treatment aims to manage symptoms only.

Paralysis of limbs –total and irreversible

Total and irreversible loss of muscle function
to the whole of any one limb.

Paralysis is the complete loss of use. It may be caused by injury or illness. A limb is an arm or leg.

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.

Parkinson’s disease is a slowly progressive disease of the brain. Symptoms can include tremors (uncontrollable shaking or trembling), muscle stiffness and slowness of movement.
Treatment focuses on slowing the progression of symptoms.
There’s currently no known cure.

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 classification’s 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.

Primary pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs.
It’s a rare but serious condition, causing a range of symptoms. These commonly include breathlessness, dizziness, fainting, chest pain and palpitations.
Symptoms can occur at rest or during mild exercise.
The New York Heart Association (NYHA) functional classification system is commonly used in the UK to assess heart function. The system relates symptoms to everyday activities and the patient’s quality of life.
NYHA Class 3 is ‘Marked limitation of physical activity. Comfortable at rest, but less than ordinary
activity causes fatigue, palpitation or dyspnoea.’
(Source: Heart Failure Society of America, 2007)
Note: Dyspnoea is difficulty in breathing.
Primary pulmonary hypertension may eventually lead to heart failure.

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.

Progressive supranuclear palsy (PSP) is a brain disease that
develops slowly. It progresses to seriously affect vision and movement. PSP can also cause changes in behaviour and
personality, memory loss and slurred speech.
As the disease progresses, the ability to swallow becomes
difficult and physical movement less stable. ‘Weighted walkers’ and wheelchairs may be needed for mobility and communication may also become more difficult.
The effect and pattern of the disease varies between sufferers.
Most cases start between ages 50 and 60, although it can occur from the late thirties onwards.
There’s currently no effective treatment or cure.

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.

The lungs allow us to breathe in oxygen and get rid of harmful carbon dioxide. This definition covers advanced lung failure when breathing is severely affected and regular oxygen therapy is required.
Respiratory failure may be described by some insurers as ‘chronic lung disease’ or ‘severe lung disease’.

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.                  

Strokes are caused by a sudden loss of blood supply or haemorrhage to a particular part of the brain.
The symptoms and how well a person recovers will depend on which part of the brain is affected and the extent of the damage. Strokes are a significant cause
of disability in the UK.
A transient ischaemic attack, sometimes referred to as a ‘mini-stroke’, is similar to a stroke. These are not covered by this definition, because symptoms aren’t permanent and will disappear within 24 hours.

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.

Systemic lupus erythematosus (SLE), sometimes called ‘lupus’, involves chronic inflammation of
body tissues caused by autoimmune disease.
Autoimmune diseases are llnesses that occur when the body’s tissues are attacked by its own immune
system, i.e. the body creates antibodies, which work against it.
SLE causes a variety ofsymptoms, which may flare up from time to time but rarely disappear
completely. These may include painful, swollen joints, unexplained fever and extreme fatigue.
‘Systemic’ means it can affect many parts of the body, from the skin to joints and kidneys.
Although it can occur at any age, it’s more common in women in their early twenties. There’s currently no known cure and treatment involves managing
symptoms.

Terminal Illness

Advanced or rapidly progressing incurable illness where, in the opinions of an attending Consultant and our 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.

This definition provides cover for illnesses or conditions where the life expectancy is 12 months or less.

Third Degree Burns – – covering 20% of the surface area of the body or 20% of the face or head

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 or covering 20% of the area of the face or head.

Third degree burns are the most serious type of burns, involving the full thickness of the skin and
underlying connective tissue.
These can be life threatening and need numerous skin grafts.
The burns must cover at least 20% of the body’s surface area or 20% of the face or head.

Total and Permanent Disability

Your plan will pay out if you are totally and permanently disabled. There are two types of cover:
1. Own occupation definition
If, when you take out your plan, your occupation is class 1 or 2, you can
choose to take the own occupation definition of Total and Permanent Disability. This means your plan will pay out if you are totally unable to follow your own occupation due to illness or an accident, and in
Legal & General’s opinion, are likely to remain so permanently.
You’ll be assessed on the occupation you were following immediately before the onset of disability. However, if you are not in gainful employment at the time of a claim, then your claim will be assessed under the Functional Assessment Tests definition described below . Full details are provided in your policy terms and conditions.

This benefit may cover any
condition not specifically
covered elsewhere, which results in total and permanent disability. The exact definition that applies
to you depends upon your
occupation and is in the policy terms and conditions.
‘Permanent’ is defined as “expected to last throughout
the insured person’s life, irrespective of when the cover ends or the insured person retires.”

Traumatic head injury - resulting in permanent symptoms

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

Traumatic head injury is covered by this definition when permanent symptoms result from the injury. An example is a severe head
injury caused by a road accident.