Critical illness cover pays out once a diagnosis meets your policy's definition and you have survived any period the policy sets after it, such as 14 days. The money follows when the insurer has the evidence it asks for and has assessed the claim.

If you are reading this because of a diagnosis, your own or someone close to you, please take it at whatever pace suits you. The sections below follow a claim in the order it usually unfolds.

If a particular policy's wording is on your mind, an FCA-authorised broker can read it with you: the short form here asks for your details, and the call that follows costs nothing.

Does critical illness cover pay out on diagnosis?

Not on the diagnosis alone. The direct version of Legal & General's policy summary (QGI14786, October 2026) requires that the illness meets its definition in the policy terms and is confirmed by a verified UK consultant whose specialism it considers appropriate; for some illnesses, symptoms must also be permanent.

What matters is whether the diagnosis, and how far the illness has gone, fits your own policy's words. Particular conditions are dealt with on whether a heart attack is covered, stroke claims, whether dementia counts and which cancers and stages qualify, with the industry's model wordings on the ABI minimum standards page, all part of our critical illness and income guides.

Between the diagnosis and the money there are several steps. This is how they line up, with Legal & General's direct policy (October 2026) as the main example:

StepWhat has to happenWhat the documents say
1. Cover in forceThe policy has started and not endedL&G's summary: cover runs from the start date to the expiry date
2. Definition metThe illness or procedure matches the policy wordingA verified UK consultant must confirm the diagnosis
3. Survival periodThe person lives through the set number of days14 days from diagnosis at L&G
4. Claim and evidenceThe insurer gathers what it needsL&G will not process a claim until it has all the information it asked for
5. AssessmentThe insurer decides, sometimes after watching whether effects lastThe ABI guide's assessment period, for conditions that must be permanent
6. PaymentThe money is paidA single lump sum to a UK bank account

How long must you survive after the diagnosis?

The survival period is the time after a diagnosis that the person must live through before the insurer pays. Not every policy has to carry one; the ABI's guide says "A survival period may apply where the benefit payable on death is different to the benefit payable for critical illness or in stand-alone critical illness cover." Where there is one, both its length and the moment the clock starts differ:

  • Legal & General (direct policy summary and terms, October 2026): 14 days, counted from diagnosis. Its terms add that the 14 days still run if the policy itself ends in the meantime.
  • Aviva Life Insurance+ (policy conditions, February 2026, from Aviva's adviser document library): at least 10 days after the life covered meets the definition of one of its critical illness conditions during the policy term.
  • Royal London Personal Menu Plan, bought through a financial adviser (plan details, July 2025, published for policyholders on royallondon.com): nothing is paid where the person covered dies within 10 days of meeting any of its critical illness definitions.
  • Royal London life insurance with optional Serious Illness Benefit, bought directly (terms, code D2C TTC 1223139355, no print date): "To be eligible to claim, you must survive for 30 days from the date you meet the relevant medical definition."

Royal London's life insurance page (read October 2026) lists each of its life cover products as available only through a financial adviser, so the direct terms chiefly concern existing holders. They still show one insurer using 10 days in one product and 30 in another: the number that counts is the one in your own terms. Other insurers' survival rules are set side by side in our critical illness cover guide.

If the person dies inside the period, Legal & General's summary says it won't pay out the amount of cover. If they live beyond the 14 days and die later, the policy may still pay out, to the estate, where Inheritance Tax may apply (see whether critical illness payouts are taxed). Death itself is covered on whether critical illness cover pays out if you die, and terminal illness benefit on critical illness versus terminal illness cover.

Is there a waiting period before critical illness cover starts?

A survival period runs after a diagnosis; a waiting period would be a delay after the policy begins before you could claim. Legal & General's summary says its cover runs from the start date, and it separates its minimum policy length from claiming: "It’s not related to how long before you can make a claim." Aviva's conditions ask for the definition to be met "during the policy term".

Cover from day one does not mean every claim is accepted. Legal & General may restrict parts of the cover at the outset because of what you tell it when you apply, and its terms say a claim may be refused or affected if application questions were not answered correctly; pre-existing conditions explains how that works. Whether a policy you are weighing up has any start-up delay of its own is something the broker can check in its terms when they ring you, at no charge.

What evidence does the insurer ask for?

Legal & General's consumer claims page says: "We will inform you of the evidence we’ll need in order to process a critical illness payout." What that is depends on the claim. Its terms ask first for the doctor's details and your contact details, then the illness and diagnosis, and add: "We won't be able to process your claim until you send us all the information we ask for."

Aviva's conditions say it has to assess a claim before paying, and the information it lists includes proof that the event behind the claim has happened and written consent to see medical records or reports. "If we ask for information from third parties, we’ll pay for it." You may add evidence of your own, at your own cost. Under the Personal Menu Plan, Royal London keeps the right to have the person seen by a doctor or specialist of its choosing, or to request further reasonable evidence, giving a GP's or consultant's report as an example.

Should it help to have the claims wording of a policy read through alongside you before you rely on it, the broker who rings after you complete the short form can do that, without charge.

How long does a critical illness claim take to pay out?

The time from diagnosis to payment is mostly the survival period plus however long the evidence takes to collect and assess, since Legal & General and Aviva each need what they ask for before settling. For a feel of how long a particular insurer tends to take, ask the broker when they call; it costs you nothing.

Some conditions only qualify once their effects are shown to be permanent, and for those the ABI's guide allows an assessment period. It says this typically begins when the claim is received and is not normally longer than 12 months, provided all the evidence is available, and that it should be used only for conditions that must be permanent to qualify.

On how often claims are paid, rather than how fast, the ABI's press release of 29 June 2026, drawing on ABI and GRiD data for 2025, says: "When looking at individual policies alone, the proportion of protection claims paid in 2025 remained strong at 97.9%." That share covers individual life insurance, income protection and critical illness claims together. For critical illness on its own, "The total value of individual critical illness claims was £1.25 billion in 2025, a 3% decrease on the previous year’s record", and "Almost two-thirds (65%) of critical illness claims were for cancer". More figures are on critical illness claims statistics.

Can critical illness cover pay only part of the amount?

Yes, on some policies. The ABI's guide uses two labels: an additional payment leaves what is left of the benefit untouched, whereas a partial payment is taken off it.

Legal & General's terms name two less advanced conditions, carcinoma in situ of the breast treated by surgery and low grade prostate cancer requiring treatment. For each it pays the lower of 25% of the amount of cover at the time its definition is met or £25,000, once per condition, and "Claims paid under additional cover won't reduce your amount of cover or change your premiums." No smaller payment is made if two or more diagnoses come within a single spell of investigation and treatment and you can also claim in full.

Aviva's Life Insurance+ conditions set the same ceiling, £25,000 or 25% of the schedule's cover amount, whichever is less (worked out differently on family income cover), for less advanced cancer of the breast or of the prostate. The 10-day survival period applies here too, and only someone who has not made, and could not make, a claim for a main benefit can use it. "If we accept a claim for any of the additional benefits, your policy will continue."

The lists of conditions differ even where the limits match. To learn how the policies an FCA-authorised broker can arrange treat smaller claims, leave your details on this page's form for a free call-back.

Frequently asked questions

Is critical illness cover a lump sum?

The ABI describes critical illness cover as a policy that pays a lump sum when the policyholder is diagnosed with a specified illness. Legal & General's terms say payments go "as a lump sum in British pounds to a bank account in the UK."

Does critical illness cover only pay out once?

For the main claim, Legal & General's policy and Royal London's Personal Menu Plan each pay the full amount once, after which that cover ends. The smaller additional payments described above can leave a policy running.

How soon can you claim critical illness cover?

Payment can follow only after the definition is met and any survival period, such as Aviva's 10 days, has passed. Legal & General will not process a claim until it has every piece of information it requests.

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