1) What if the Illness Falls Outside the Insurer’s Definition?

Before you take out a specified illness policy, read carefully through the terms and conditions.In there you’ll find a list of the critical illnesses covered and how the insurer defines the illness.Before the insurer can pay your critical illness claim, your illness must satisfy the definition.As an example, here’s the definition of cancer:Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of cancerous cells and invasion of tissue.but you’ll also find an exclusion for low-grade prostate cancerAll 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.Therefore, although your policy covers prostate cancers, the actual type of prostate cancer that you get has to meet the definition.The prostate cancer must have a Gleason score greater than 6 for you to get a full serious illness payout.But you can qualify for a partial payout.

2) What is Non Disclosure?

At its simplest, this is telling porkies on your application form , e.g. declaring that you’re a non-smoker even though you have smoked in the last 12 months.But what if you make a genuine mistake on your application form?And how are you meant to remember things from years back?Have a look at this Irish case where the insurer had to pay the critical illness claim even though the insured forgot to mention a material fact. In this case, a critical illness claim for MS was upheld in the Courts even though the life insured failed to mention that she had undergone tests for eye problems (her symptoms were indicative of MS) eight years before taking out her policy.The Court case found in her favour and awarded her €95,230.76 representing the payment that should have been received by Ms Coleman at the time of her claims together with interest.

Do Insurers Pay Income Protection Claims?

Aviva, our preferred income protection provider paid over 90% of income protection claims last year.With income protection, there is another spanner in the works when it comes to claims.It’s called the deferred/waiting period – the time you must be out of work before the insurer can pay your claim.So how does the deferred period affect your claim?Let me give you an example:Johnny has an income protection policy with a deferred period of 26 weeks.He falls ill and can’t work.After 13 weeks out of work he makes his claim, but before the 26 week period is up, he gets back to work, so he cancels his claim.Aviva would have to record this as a declined claim 🤷♀️

Will Your Critical Illness Claim Payout?

Q: Will Your Critical Illness Claim Payout?

Also I have read in forums that it can be difficult to actually get a critical illness claim to pay out!I hear this so often.I’d love to know who’s spreading these scurrilous rumours!Car insurance and house insurance can be nigh on impossible to sucessfully claim, but serious illness cover is different.However, it’s normal to worry that the insurer will pocket your premiums and then reject your critical illness claim.Although life insurance providers will decline some claims (usually because of lying on the application form👇), if you have a genuine claim that meets the definition of the illness , they will happily pay out.If the insurers don’t pay claims, then what’s the point of serious illness cover?This why they welcome claims so they can prove how important serious illness cover is.So, let’s go back to why an insurer may refuse to pay a claim:

Nick McGowan - QFA RPA APA Qualified Life Insurance Advisor

November 4 2025 5 min read Specified Illness Cover

Table of Contents

Editor’s note: First published 2019 | Refreshed November 2025 with updated 2024 insurer data, real claim examples, and payout trends from Aviva, Zurich, Irish Life, Royal London, and New Ireland.

10-second summary: Around 90–95 % of critical illness (serious illness) claims in Ireland are paid every year. The few that aren’t? Usually, because the illness doesn’t meet the insurer’s definition, or something important wasn’t disclosed on the application.

Do Insurers Actually Pay Out Serious Illness Claims?

You might have seen people online saying “critical illness never pays” — but in Ireland, the numbers tell a different story. Irish insurers do pay out most of the time. The key is meeting the illness definition and being upfront on your application.

When a claim does fail, it’s almost always for one of two reasons:

The illness doesn’t meet the medical definition in the policy wording.
There was a non-disclosure — something left off the application that would’ve changed the underwriting decision.

Let’s look at how Ireland’s biggest insurers handled real claims in 2024.

2024 Serious Illness Payouts at a Glance

Irish Life: Paid out €64 million in Specified Illness Cover (SIC) claims, with a 92 % payout rate. Most claims were for cancer (63 %), heart-related (17 %), stroke (6 %), and multiple sclerosis (2 %). Average claim: €76 000.
Zurich: Paid €88 million in combined life & serious-illness claims. 80 % of illness claims were for the “Big Three” – cancer, heart, or stroke.
Royal London: Paid €11.8 million in 2024, with 62 % of claims due to cancer. Average claim €70 246; largest €650 000.
Aviva: Paid 82 % of specified illness claims in 2024, totalling €11.1 million. Average claim €414 000 (largest individual payout).
New Ireland: Paid 442 serious-illness claims and declined 47 (42 didn’t meet definition, 5 for non-disclosure). Average payout €76 387; 64 % were cancer-related.

When you see consistent 80–95 % payout rates across every insurer, year after year, it’s clear these policies work when you need them most.

What Causes Most Serious Illness Claims?

Cancer continues to dominate. In 2024:

Irish Life – 63 % of claims for malignant cancer
Royal London – 62 % cancer-related
Aviva – 64 % of all claims for men; 85 % of female claims were for cancer
New Ireland – 64 % of specified illness claims for cancer

Heart attacks and strokes follow, then neurological conditions like MS or Parkinson’s.

Serious illness cover mostly protects against the big, common conditions that upend families overnight.

Here are New Ireland’s stats from 2024

Why Claims Get Refused

1. The Illness Doesn’t Meet the Definition

Every insurer has its own medical definitions. To get a payout, your diagnosis must meet that exact definition — not just sound similar.

Example: A policy might cover prostate cancer only if it’s above a certain Gleason score. Early-stage or low-grade forms could trigger a smaller partial payment instead of the full lump sum.

2. Non-Disclosure

If you accidentally (or intentionally) leave out a medical detail that would’ve affected your underwriting decision, your claim can be refused.
That’s why we spend time going through your health history carefully before applying — not to be nosy, but to protect your future claim.

Real case: An Irish court upheld a woman’s MS claim even though she forgot to mention eye tests eight years earlier. The judge ruled it wasn’t intentional — and the insurer had to pay €95 000.

3. Policies That Lapsed

If your cover wasn’t in force at the time of diagnosis — maybe a direct debit failed or the policy was cancelled — the insurer can’t pay.
Most give you around 90 days to catch up missed payments, so check now and then.

Real Examples from 2024

A 40-year-old woman with a neurological condition received €545 000 from New Ireland.
A 31-year-old man claimed €228 000 for cancer just one year into his policy.
A Royal London claimant in their 50s received €650 000 after a cancer diagnosis.
Irish Life paid out €750 000 on a 25-year policy for cancer.

How to Make Sure Yours Pays Out

Answer health questions honestly — even if it means a slightly higher premium.
Keep payments up to date (via direct debit from your main account).
Work with a broker who understands each insurer’s definitions — that’s literally what we do every day.

If you ever need to claim, we’ll handle the paperwork and deal with the insurer so you can focus on getting well.

The Bottom Line

Critical illness (serious illness) cover works. Roughly 9 in 10 Irish claims are paid; the few that aren’t usually involve a missed definition or non-disclosure.

To see how life insurance payouts compare, read our Life Insurance Claims Guide.
Or if you’d like a second opinion before applying, fill out our quick questionnaire, but don’t be surprised if we recommend income protection over serious illness cover.

Written by Nick McGowan, QFA RPA APA

Nick is a qualified financial advisor and founder of Lion.ie, an independent Irish brokerage based in Tullamore specialising in life insurance and income protection. He’s been helping people get fair, transparent cover for over 15 years and was named Protection Broker of the Year 2022.

Learn more about Nick

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