PPI Reclaiming discussion Part III

di3004

marshallka wrote: »

Di I would be very surprised if they pay out for the illness as it states that you have to have been under a consultant directed to by your doctor. It doesn't matter about meds etc.. its about being under a psychiatrist or psychologist that your doctor sent you to... It states it here

any condition of a mental or nervous origin including stress, anxiety or depression (unless a suitably

qualified

consultant certifies that the condition prevents you from working, or you have been referred to,

and receive ongoing treatment from an appropriate medical specialist on the recommendation of

your
doctor);

I don't know of any policy that pays out for stress related illness's unless you are actually under a consultant for it and that is very different to a doctor.

A doctor is not a consultant and a doctor is a not a professional in mental illness. In fact they are not specialists in anything and that is where they differ for insurance purposes. It has to be a consultant.

Its the same with back related conditions, they will not pay out if you say yu have back ache and the doctor writes you a note for you not to work. They have to have a consultant in back related injurys etc to either xray or mri and then they MAY pay you. It all depends on what the condition is actually called in medical terms.

backache or related conditions where there is no physical or radiological evidence (for example an MRI) of

a medical abnormality (unless a suitably qualified

consultant certifies that the condition prevents you from

working, or

you have been referred to, and receive ongoing treatment from an appropriate medical specialist
on the recommendation of your doctor);

Was your hubby referred to a consultant over the stress/depression etc. ?? Lots of people work on the meds so the meds mean nothing to insurance claims. It actually highlights the word "consultant" in the terms and conditions.

Here is what happens when you visit your GP

What should you expect from your GP?

• Your GP makes the initial diagnosis and will give you advice on your illness.
• Your GP will make the decision to refer you to a specialist (hospital consultant).

Sorry to put a downer here Di but would not want you to be banking on this one as believe me they will go strictly by their terms and conditions...

lol, just posted above about this and was meant to post on this one , yep it was the GP who made the diagnosis and he seen the specialist as advised by the GP only twice, that was it......

maxdp

pinknico wrote: »

Evening everybody , sorry you are having such problems Di, I hope this all gets sorted:A

WOW Max and Marshallka where do you get your energy. All I have done today is clean the fridge:D

Hi Pinknico

Cleaned mine in between painting but only got down to the third shelf and there was the wine It was a shame to leave it so I gave it a go:rotfl: Have carried on painting and am now cooking dinner so god help us:beer:

maxdp

marshallka wrote: »

Its here maxdp. The independant assessor

http://www.financial-ombudsman.org.uk/about/IA_terms_reference.htm

Might do this about my firstplus complaint!!!:rolleyes:

Thank you Marshallka. Wonder if I should get details first then see if I can go to our friend. If I go to the above I may mess that up am in a quandry really

marshallka

Who was the specialist. Was it a psychiatrist or psychologist.??

These are the only two "consultants" in mental illness. And it has to have been an actual doctor of mental illness being either of the above.

marshallka

maxdp wrote: »

Thank you Marshallka. Wonder if I should get details first then see if I can go to our friend. If I go to the above I may mess that up am in a quandry really

Yeah get your SAR and then take it from there maxdp... I am now waiting for the insurance company to write back with a knockback and then I will take it from there also;) .

Just want to see what the Ombudsman Service is really made of first... . I thought they looked at complaints like mine...:rolleyes: . Just have to wait and see.:D

di3004

marshallka wrote: »

Who was the specialist. Was it a psychiatrist or psychologist.??

A psychiatrist, but will ask him again when he comes home, I do have his details here somewhere but I am sure it was that one.
I did not go with him, but the last time he went was in October, where hubby told them he was feeling more himself again, they did recommend that he stays on the higher dosage of meds which were prescribed by his GP for the next 6 months and any further problems is to see the GP again where they will always refer him again.
Lets hope it doesn't come to that.......:eek:

di3004

pinknico wrote: »

Evening everybody , sorry you are having such problems Di, I hope this all gets sorted:A

WOW Max and Marshallka where do you get your energy. All I have done today is clean the fridge:D

Thanks Pinknico.:A
Time will tell I suppose lol, the sooner he gets back to work the better, I don't know if I'm coming or going with all this different stuff going on....:rolleyes: .

marshallka

di3004 wrote: »

Yes I was just reading on that now, although he did see a specialist at a local hospital twice, referred by the GP, not ongoing though.:rolleyes:

What was this a specialist in??? Was this to do with the back related condition or mental illness specialist.??

What did they say then?? What did they diagnose??

I remember watching that documentry about the loans being voided etc on Panorama and there was a step daughter who was claiming for this and her step dad was actually in a mental hospital and they demanded that she give them all details which she did about his illness and they still expected payments for the loan although he was sectioned. They are very strict in the stress related problems and meds mean nothing as most of the country is on something and works with them too.

marshallka

di3004 wrote: »

A psychiatrist, but will ask him again when he comes home, I do have his details here somewhere but I am sure it was that one.
I did not go with him, but the last time he went was in October, where hubby told them he was feeling more himself again, they did recommend that he stays on the higher dosage of meds which were prescribed by his GP for the next 6 months and any further problems is to see the GP again where they will always refer him again.
Lets hope it doesn't come to that.......:eek:

Wasn't that the works doctor though?? I thought you said it was the works doctor who said that or your own GP???

It won't happen again as he has been signed off now Di... Don't think like that. He will be fine and better getting into doing things again and earning money or at least trying to. Often men are better working than not I think. They are so different to women who can amuse themselves at home but men just can't do what we can do and need to bread win. They need a purpose in life...and its the same as single parents too. They have to try to balance the lot of earning, and being mum and dad but they manage. At least he has your support and you are at home all day.

You need to jog him along and not look back. That part is over now and its a new year and new beginning. He needs to work Di... Thats part of the problem and if he is signing on for a while at least he is actively seeking work and the docs have signed him as fit for work.

di3004

marshallka wrote: »

What was this a specialist in??? Was this to do with the back related condition or mental illness specialist.??

What did they say then?? What did they diagnose??

I remember watching that documentry about the loans being voided etc on Panorama and there was a step daughter who was claiming for this and her step dad was actually in a mental hospital and they demanded that she give them all details which she did about his illness and they still expected payments for the loan although he was sectioned. They are very strict in the stress related problems and meds mean nothing as most of the country is on something and works with them too.

The Shoulder and back/neck problem was yet another issue, even though the GP had added this info on the form we had to send, the problem they had for being off work was "Depression" although the doctor did say to hubby that this condition was not helping with his situtation with his other problems... , he was under a physio for this and separate, he was going every 2 or 3 weeks for physio.

I think I seen a bit of that programme as well.......:eek: , well if they do not pay out on this one, as we did not expect them to in the first place anyway, it was only because the lady said for him to do this, and if they deal with the unemployment one that is the main.;)