Your critical illness cover is there to help you with the additional expenses that come with a serious illness or injury. But does your cover consider traumatic injuries when assessing your claims? Here are some important questions to ask when getting critical illness cover.
1. Should my critical illness cover include cover for injuries?
Yes – injuries are just as likely to result in additional expenses that you haven’t budgeted for as illnesses. Everyone’s at risk of having an accident, even if you’re super healthy. It’s important to consider the impact that a fairly serious injury could have on your finances. For example, falling off your bicycle, hurting your knee and having to go for surgery to repair the joint. If you have medical aid, it will cover most if not all of the expenses around the medical interventions, but what about having to use an Uber to get to and from work because you can’t drive? A medical aid won’t pay for that. That’s exactly what your critical illness cover is for – to cover the additional expenses that come with suffering a serious illness or injury.
2. If my medical aid covers traumatic injuries, why would I need my life insurance policy to cover them as well? Is this the same as gap cover?
No, critical illness cover is not gap cover – gap cover only covers medical costs not covered by your medical aid plan. You need critical illness or additional expenses cover to pay for things that your medical aid doesn’t pay for. Say for example you’re diagnosed with cancer and you need to go for chemotherapy. Your medical aid will most likely cover the actual medical treatment. But what about things like taking your children to school and cooking dinner when you’re feeling unwell after your treatment? A pay-out from a critical illness benefit would help with things like hiring some help around the home and transport for your children.
3. What do I need to do to qualify for pay-outs for traumatic injuries? Can I treat my injuries myself at home?
For a small injury, you can definitely treat it at home and put on a plaster, but these types of injuries would not be severe enough to qualify for a payment from your life insurance policy. An insurer would consider a payment for an injury where the injury is quite serious, and needs to be treated at least in an emergency room, or by a qualified doctor. These are the types of injuries that would result in additional expenses that you didn’t anticipate, and that could result in a Trauma IQ claim payment at BrightRock.
4. What kind of injuries qualify for pay-outs? Can I get a pay-out if I sprain my ankle?
A sprained ankle probably wouldn’t result in a claim payment as the treatment wouldn’t be invasive or long-lasting. If you broke your ankle badly and needed surgery with some physiotherapy afterwards to make sure that it healed well so that you can walk and run again properly, this would be more likely to trigger a Trauma IQ claim at BrightRock as this would be likely to come with additional expenses.
5. Do all insurance companies cover traumatic injuries?
Even though current naming conventions don’t seem to suggest this (critical illness cover, dread disease cover, etc) most life insurers would cover injuries, but generally only those that are really severe such as burns to a significant portion of your body, and permanently losing the use of limbs because of an accident. Only BrightRock covers accidental events that are lower in severity but still have an impact on your pocket, like an Achilles tendon repair after playing padel, or hurting your arm badly after falling off some rocks at the beach.
6. How serious does the injury need to be to qualify for a payment?
At BrightRock, the injury needs to be bad enough that you seek medical help within four weeks of the date that you hurt yourself. It also needs interventions such as surgery, or hospitalisation, or rehabilitation. We look at nine different factors to assess how serious the injury was in terms of the interventions needed to fix you up again.
7. But what about my children? Should they be covered for accidental injuries as well?
Yes, of course! Children often injure themselves on sports fields and in the garden, and more often than not they recover quite quickly without any aftereffects. But where your child is hurt badly, for example, after falling off the top bunk of a bed and undergoing multiple surgeries on their shoulder, then this would incur additional expenses and could possibly qualify for a pay-out if the injury is severe enough.
This article was first published on Lifestyle & Tech on 24 March 2025.
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