How long des a Critical Illness Claim take?

mysmeg

This is maybe a more specialist query, but hoping somebody might have some knowledge on CI Claims out there.
We claimed for my 37 year old husband the 2 weeks in June - 3 weeks after diagnosis.We have a policy with Legal and general which reduces in amount of pay out every month.
So far they have obtained hospital consultants reports, gp reports and then 2 months ago asked for more information from GP which has all been supplied too- beleive they are going back to day dot.
It is now 4 months and we haven't heard anything - just holding letters. My husband hasn't phoned them, because he is scared of losing the wrag on the phone.

Does anyone know if there is a time limit for settling these types of claims? We were taking no news as good news originally, but now feel it is obvious they are going out of their way not to pay us. We must have a "good case" for it to have taken so long? Its a horrible thing to say, as I wish we didn't have to make a claim like this ever.
The thought of an appeal and lengthy pursuit of this fills us with dread, as we just aren't up to it emotionally. I also lost our baby back in June, in the middle of all of this happening to us.

Thanks for any help folks

zuzuspetals

I'm sorry that you are going through a stressful time.

I used to work in Life Insurance, and I'm afraid there is no "set time" as such. It isn't unusual for things to take ages to be processed when medical records are involved.

Providing the claim is accepted, they will have to backdate it to when the claim was originally submitted, so don't worry about the sum assured decreasing in the meantime.

If your husband feels unable to speak on the phone, then send a letter (recorded delivery) asking for a decision (give them a date to reply by) or you will make a complaint to the financial ombudsman. In my experience a complaint or mention of the ombusdman tends to speed things up a bit!
Sometimes it is easier to complain by letter, as it is difficult not to become angry or emotional on the phone. I hope that your husband gets well soon.

grogdog

why cant you phone and chase it up rather than waiting on the post everyday at least it will give to some piece of mind.

did you buy the policy through a broker and if so has he/she been involved in the process of the claim.

the company are probably ensuring everything was disclosed at time of applying but under the ABI rules they can only request details regarding to the claim and not trawl through all your husbands details looking for any reason not to pay out.

it does seem quite a long time to get it resolved but it could also be due to doctors or consultants not returning infromation requested, as i said give them a ring and chase them up they are normally guite helpful and will tell you what is going on.

Tighthead

I'm sincerely sorry to learn of your recent events. Agree with the previous posts.

If you bought this policy through a financial advisor, get them to do this for you; that's their job, and partly what they got paid for and one of the reasons for using an advisor in the first place. Oddly enough, it's one one of the 'good' things about being an advisor sometimes, in that you know that you did the right thing in making the recommendation in the first place.

If this is a joint life policy, then why don't you give L&G a call? If it's a single life policy in your husband's name, then he will have to give you authority to call on his behalf, or phone himself.

I suspect there is a very reasonable explanation, and they're just being thorough (wouldn't you if you were liable for thousand's?), but just haven't been particularly good at keeping you informed.

Call, and ask to speak to the Claims Dept. and if possible the person dealing with your claim. No need to start threating with the Ombudsman just yet.

Best of luck, and keep us posted?

mysmeg

Thank you all very much. We are going to call them tomorrow. There are two elements to this CI - a joint policy (smaller sum ) and a single one for my husband. The claim is on both policies - it is probably better if I call instead of him.

Tighthead - the financial advisor is the first person I contacted regarding this, and she never got back to us, which was very disappointing.

I actually looked at the paperwork involved and she received £650 from L&G when we took out these policies.

Another point is that the policy is just 4 years old, could that explain why they are being more thorough I wonder.

Thanks for your time folks.:T

grogdog

no i dont think so, i had a policy started on the first of the month and the client died suddenly less than 2 weeks later, they paid out within 8 weeks.

the-chauffeur_2

This may sound strange, but the length of time it takes for the insurer to investigate will depend to some degree on exactly what illness has been diagnosed.

The policy 'tests' for some conditions are fairly straightforward; others are less so. For instance, being diagnosed with a tumour (commonly referred to as cancer) does not automatically qualify the policyholder for benefits. Before the insurer will accept a claim, it needs to see medical evidence confirming the condition meets all of the definitions in the policy terms. In the case of tumours, they need to be shown to be malignant, invasive, and characterised by uncontrolled growth.

At the same time, don't assume that all of the medical people involved have responded as quickly as you'd imagine. It's not uncommon for specialists or GP's surgeries to be very slow to respond because of the other pressures their services are under. And the insurer may delay its decision if there are ongoing medical investigations.

There's no set time, or time limit for that matter - but it's not in the insurer's interest to delay making decisions without good reason. You'll almost certainly find that the insurer is taking time simply because it's doing a thorough job. Nothing unusual in that, but you may need to be patient.

HTH

mysmeg

Thank you Chauffeur
I telephoned L&G today and was told that a letter was sent to us just today confirm the claim will not be paid. So I guess, we have to look through that when it arrives and see what happens next. But I do know we won't accept this decision without a fight and will do whatever it takes. We feel out claim was very strong, without going into the illness etc, and I wondered if when an insurer is perhaps left in quandry where they might choose to pay or/not, how much discression is there for claims handlers/managers. There must be cases like that that come up a lot. My husbands life expectancy is approx 5 -10 years depending on his condition progresses - is he not going to die quick enough for these people???

I feel sick and angry - but guess what - not surprised.

dunstonh

CI policies pay out on diagnosis with most illnesses. The criteria they set on policies is quite explicit with most illnesses. They will rely on medical information though. So, you may want to check out what was said. obviously, its difficult to comment beyond that without knowing the facts. Some conditions are harder and can state a degree of illness and that if it is a illness like that then it could be where there is a problem.

CI typically pays out in around 85% of claims so it does have a good claim to pay out ratio. 10% of claims are generally rejected as the illness isnt covered (some people mix up critical illness cover and terminal illness cover or income protection) and 5% is due to non-disclosure.

grogdog

again without knowing all the details, your husbands condition at present may not match the critical illness defintion set out in the policy at outset, this however does not mean that it may not be paid out at a future date as the condition worsens.

the-chauffeur_2

Hmmmm.

Sorry to hear about the rejection.

Not that it's any help right now, but bear in mind that a 'life threatening' illness is not necessarily a 'critical illness' that is covered by the policy. As a very extreme example, something like rabies is a life threatening (and very often fatal) illness, but the insurer would be entitled to reject a claim for it because it's just not covered.

And life expectancy has no bearing on whether the claim is accepted - sounds harsh, I know, but at the risk of repeating the above comments, the decision will have been based on the policy terms and whether the medical evidence shows that all of those terms have been met. Same goes for a GP's/consultant's definition of a medical condition; it doesn't matter how the doctor(s) refers to the condition - if the policy criteria aren't met, the claim won't succeed.

Read the insurer's rejection letter carefully when it arrives - it should tell you all you need to know and put you in a better position to decide what to do next. You can always ask the insurer for clarification if there's anything you're unsure on - and you may also find it useful to discuss the policy conditions and rejection letter with your husband's doctor(s).

Good luck.