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CHAPTER 7 LIFE AND PERSONAL ACCIDENT

Insurance Law and the Financial Ombudsman Service

7 LIFE AND PERSONAL ACCIDENT CHRONIC CONDITIONS 7.1 Private medical expenses insurance usually excludes “chronic” (i.e. not curable) conditions and limits cover to “acute” (i.e. treatable) conditions. The exact definition of what is included in each section may vary from policy to policy. The FOS considers these to be significant terms to be explained to insureds before inception, along with a warning that an acute condition can become redefined as chronic, and alleviation of chronic symptoms will not be covered. The FOS will look at the policy wording and the medical evidence to determine whether a medical condition falls within the chronic conditions exception.

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