FOS can't help with my critical illness claim. Pl...

[karry1964]

When my husband and I moved to our new house in 2001 we took out a life assurance policy with critical illness cover with L&G through a brooker called Lifesearch. In 2004 we approached Lifesearch to increase the level of cover following an increase inour mortgage. They advised to keep the existing policy and take out an additional policy. We agreed as long as the additional mirrored the existing, i.e. with critical illness cover. In 2008 I was diagnosed with Grade 3 breast cancer. Following a masectomy, chemotheraphy and radiotherapy and no longer able to work I made a claim against the critical illness cover only to be told that the critical illness cover had been removed when the new policy was taken out. Since then the two companies, lifsearch and L&G have just been blaming eachother. I decided to take this to the FOS who have now told me that it is outside their jurisdiction as the policy was taken out in 2004. Had it been 2005 they could have considered the case. Is there anything I can do other than just give in and continue to suffer the financial hardship this has caused?

Please help if you can.

[antrobus]

Originally Posted by karry1964

.. Is there anything I can do other than just give in and continue to suffer the financial hardship this has caused?

Get a lawyer.

[kingstreet]

So, the new policy was taken out to run alongside the existing policy and not to replace it?

It isn't clear what's happened here.

If the original policy was still running it would be unaffected by the new plan and if you meet the cancer definition, you should at least be able to claim on the earlier contract.

Can you tell us how the new plan was bought - was it an advised sale? Did you receive a suitability letter from the broker explaining how the new plan met your needs and how it fitted with the existing policy?

IMHO if a new plan was taken and it replaced the old one, it would be down to the broker to ensure it met your needs and to make sure it didn't replace the old one if the terms were not equal to, or less favourable.

If this was an error and somehow the insurer managed to replace one plan with another without being instructed to do so, the liability should rest with them.

You went through the complaints procedures of broker and insurer receiving final outcome letters from both, then attempted to escalate to FOS who are denying jurisdiction as the latter was pre-15/1/2005?

[karry1964]

The new policy was taken out to run alongside the exisiting policy. This was the instruction given to Lifesearch. This was an advised sale by lifesearch. We were told that it would be better to take out a new policy to cover the increase in our mortgage and leave the existing policy as it was. We did not receive a suitability letter.

What actually happened without our knowledge was that the exisitng plan was replaced with one that no longer included critical illness cover and the second new plan was also provided again not including critical illness cover. Lifesearch have admitted that they have no record of any written instruction from us or a record of any telephone conversation that gave them an instruction to remove the critical illness cover.

We received a final letter from L&G but could not get a final letter from Lifsearch. We informed the FOS of this and were advised by them that this did not preclude us from making a complaint. We therefore made the complaint to the FOS who have now denied jurisdiction as the latter was pre-15/1/2005.

[kingstreet]

Have you made a Subject Access Request under S7 of the DPA to them both?

It seems the best way to approach this is to establish what, and obtain copies of, any information both organisations hold on you. This should also enable you to see any communication between the two.

They'll probably charge you £10 for the privilege, but it seems like the logical first step, particularly if you undertook an advised purchase, but received no suitability letter.

This is a copy of a section of a suitability letter I wrote a few years ago where I was replacing an existing policy. This is the kind of thing you should have received;-

During the course of our discussions you have given me information about your circumstances and the insurance cover you require, as follows;-

-life and critical illness cover is required for the amount of your outstanding mortgage, currently £123,000, should anything happen to either of you with the sum assured decreasing as your mortgage is repaid

- unemployment cover is required in the sum of £750 per month to contribute towards your mortgage and some of your other outgoings, following a one month waiting period in the event of Steve losing his job through no fault of his own, with the benefit being paid until he finds another job or the expiry of twelve months from the start of the claim whichever comes sooner

- income replacement cover of £600 per month is required to contribute towards your mortgage and some of your other outgoings in the event of Steve being unable to follow his own occupation due to an accident or illness following a twenty-six week waiting period, until he is fit enough to return to work, or the end of the mortgage term, whichever comes sooner

- income replacement cover of £450 per month is required to contribute towards your mortgage and some of your other outgoings in the event of Kim being unable to follow her own occupation due to an accident or illness following a four week waiting period, until she is fit enough to return to work, or the end of the mortgage term, whichever comes sooner

Waiver of premium and cover increase options were discussed and rejected on grounds of cost. We discussed the unemployment benefits for Kim but you felt you could continue to maintain your living standards on Steve's income alone. I suggest you review this issue regularly.

You will cancel your current YYY Unemployment Cover to replace it with cover from XXX. XXX will not meet a claim under this cover if it takes place within thirty days of the policy inception. You may, as a result, wish to continue your existing cover until that period expires.

You will cancel your existing Norwich Union protection plan following the commencement of your new plan. Following our discussions you feel this plan no longer meets your needs and it cannot be altered to reflect the changes in your circumstances.

In the event of any medical underwriting problems with your new application, I suggest you consider this carefully and take no action to cancel your existing policy until you are completely happy with the terms of the new plan.

It clearly explains the reasons why actions are recommended and how they refer to discussions held.

[karry1964]

Have not made such a request but will do. We did not receive anything resembling the example you have kindly provided. Do you advise contacting a solicitor?

[kingstreet]

You need to get all the documentation you can from both companies, so you can see each "end" of the process in full.

Once you have that, you can identify what has happened and this will enable you to identify the guilty party and formulate an approach.

If you go to a solicitor now, you'll simply be asked to get all the documentation together on which you'll base any claim/action. If you get it now, you can use up your free half hour a bit more constructively when you can put physical documents in front of a solicitor for their consideration and comment.

You need to be looking for how/why/when L&G cancelled the existing policy and on whose instructions...

[lisyloo]

The new policy was taken out to run alongside the exisiting policy. This was the instruction given to Lifesearch. This was an advised sale by lifesearch. We were told that it would be better to take out a new policy to cover the increase in our mortgage and leave the existing policy as it was.

Do you have any evidence of this at all? or is this just your memory of events from 2004? What paperwork do you actually possess.

Your memory of events from 8 years ago about who said what to whom isn't enough, you need paperwork.

[karry1964]

I have the existing policy and the new policies. I have written records of telephone conversations with Lifesearch and I have a final written communication from L&G.

[lisyloo]

If you exhaust the complaint procedure then it sounds like it's up to you to take civil action. Do you have any free legal cover on your household insurance? Would it cover you?
It would seem to be in your best interest to exhaust the free complaints procedures first before considering legal action.

[weighty1]

Very few companies allow brokers to cancel a clients policy. It generally has to be done by the policyholder themselves to try and avoid situations like this. The new L&G system does allow existing plans to be replaced by new plans where the broker has the existing policy numbers, however, I cannot recall that this use to be the case.

From what you are saying the error appears to be leaning towards that of L&G. As you say, the LifeSearch broker recommended keeping the existing plan and just taking a top-up - generally good advice in many situations but somehow that plan was replaced by a life only plan. I cannot see how this has happened without the original plan either being cancelled by you, or an error by L&G?

Hope it gets resolved though.

[karry1964]

Just a quick update especially for Kingstreet. I have contacted both Lifesearch and L&G to establish who to write to and the cost for a Subject Access Request. L&G provided the answers immediately and no cost. I was passed to 3 people at Lifesearch and after about 10 minutes was told by the third person that he would have to make further enquiries and someone would get back to me. No reply and now they are closed for the day. Will keep updating but thank you all for your help today.

[dunstonh]

This should a very simple case of finding out responsibility. Setting up a standalone second policy would have no impact on any existing policy. So, if something has affected the first, then L&G should have the audit trail to show who, why and how.

It sounds like the whole plan was replaced. Were you making two payments by direct debit or just one? Was the direct debit cancelled by you? What information did L&G have to cancel the original policy?

If you were making one payment then that would be a new sale. That sale would be the liability of the seller. However, as it is pre-regulation, you dont get access to the FOS and if the company do not agree to review your complaint voluntarily then court is your only choice.

Even though it was pre-regulation, advisers still issued reports on the recommendation. However, this leads to the another potential issue. Was this an advice case (did you go through the factfind process, receive advice and a report about the advice) or was it using their non-advice process to get cheaper premiums. If it is non-advice, they should be order taking rather than telling you what you need. However, it is not uncommon for order takers to cross the line. In a post regulation case the FOS would consider that and they have said they have seen that happen (recently documented in their publications). However, the pre regulation date doesnt help you.

[karry1964]

When the additional policy was taken out an additional Direct Debit was also created to cover this policy. From that day to the present two Direct Debits to L&G come out of my bank account on a monthly basis to cover the two policies. I did not cancel the original Direct Debit. I have made an information request to both Lifesearch and L&G asking for the following:

• Records of any communications between yourself and Legal and General regarding the cancellation of the original policy number
• Why the original policy was cancelled
• When the original policy was cancelled
• On whose instructions was the original policy cancelled
• Any signed policy cancellation documentation regarding the original policy
• Records of any communications between yourself and Legal and General regarding the new policies

All of which will hopefully provide evidence of who was at fault.

The policy to cover the increased mortgage was discussed over the telephone. I contatced L&G to be told that they could not discuss this as the original policy was brookered through Lifesearch I had a telephone converstaion with Lifesearch during which they advised that the original policy remains in place and a new policy is taken out to cover the additional mortgage amount. The new policy was to match the original in that critical illness cover was to be included. Unfortunately Lifsearch has informed me recently that they did not record telephone converations when this change was discussed.

[dunstonh]

If the premium for the original continued unchanged then I cant see how the cover was reduced unless it was never there in the first place.

[magpiecottage]

Although Lifesearch cannot be taken to FOS over a 2004 policy, I am fairly certain the L&G aspect of if falls under the voluntary jurisdiction at FOS. If necessary, ask FOS for an ombudsman's decision on jurisdiction.

[karry1964]

I have been told by the FOS that the claim must be against the brooker (Lifesearch) and not L&G. Do you think that I should seek further advice from the FOS?

[kingstreet]

I would keep your SARs as general as possible, don't ask them for specific information. Ask simply for "any and all information you hold on me, including any communications with, and from, third parties."

Put the request in writing to the Compliance Manager, Lifesearch, obtaining proof of postage from the PO when you send it.

Until you get this information, it's pointless going to and fro with the FOS or anyone else. You need to see a clear trail of how this policy was sold and how it impacted on the old one, before you can go any further.

You are trying to build a house. Put the foundations in place before you start looking for where to stick the roof.

[karry1964]

Will do and thanks again for your advice.

[kingstreet]

Compliance Manager
LifeSearch Limited
Epworth House
25 City Road
London
EC1Y 1AA

Dear Sir,

Name DoB Address
Data Protection Act 1998 - S7 Request

With reference to the above, please supply me with any and all information you hold on me, including any communications about me with third parties.

If a fee* is required for this, please let me know the amount and I'll remit by return.

Yours faithfully.

*You could take a flyer here and send them a cheque for £10 instead, as this is the maximum a non-statutory body can charge IIRC.