PPI on loan for car - wont pay

wendy_

pedro123456 wrote: »

Wendy sorry to be a pain but 3 more questions in red.
Q1-Is this a accurate account of the events in a date wise order?
1- your friend found a swelling on the side of his neck in Feb 08 on the side and presumed this was the result of a ear infection
2- He attended the GP surgery for the first time in Feb08 with this swelling and it was also thought by the GP to be a ear infection, he was treated with Antibiotics that had SOME effect but didn’t totally clear it.
3- He then again attended his GP in November 08 because it hadn’t cleared up completely and the GP then decided to investigate further,
4- He took out a PPI policy in December 08 for whatever reason.
5- The GP sent him for further investigations in Jan 09 and he was diagnosed as having CA of the throat approx 1 month later in Feb 09.
6- He was diagnosed as having CA of the Tongue
7- Because of his communication skills he is now unable to talk personally to the IC and the IC won’t engage in conversation with his wife.
8- The IC “presumes” that because he had the lump/swelling to the throat he KNEW he had throat cancer? Before he took out he policy? they expressed this verbally
9- The IC will now not let him claim “verbally”

Q2-He has been diagnosed as having CA of the tongue, has any reference been made to Cancer of the Lymph glands?
Q3- Has his Consultant got any opinions as to the swelling to his neck, and the likelihood of this being a sign/symptom of CA tongue

Q2-He has been diagnosed as having CA of the tongue, has any reference been made to Cancer of the Lymph glands? - No reference has been made to Lymph node cancer
Q3- Has his Consultant got any opinions as to the swelling to his neck, and the likelihood of this being a sign/symptom of CA tongue - He was told that the lump on his neck was a secondry, this has now gone with the chemotherapy treatment. his radiotherapy treatment is for the tongue cancer. Apart for that the rest is correct.

wendy_

dunstonh wrote: »

Not really. Take pedro's posts out (which many of us here cant see anyway as he is on ignore) and you have a pretty normal thread.

that is the one that does the claim damage. It was first looked at in Feb 08. Cover would need to have been in force before then.

Remember that it is not diagnosis or medication or outcome that matters. Its the point the condition first became aware. That is in Feb 08. Nine months before cover started.

Also, looking at it without any emotion attached and from the outside, it does smell a bit like a fraudulent claim. I dont know if it is or it isnt and I am not going to judge anyone. I am just presenting it as it will be looked at (plus keeping it to the point in text can appear colder than you mean it to):

1 - Policy started in Dec 08.
2 - Claim put in just weeks later. (that is the first warning bell to an insurer of a possible fraudulent claim).
3 - Condition started 10 months earlier and GP was seen AGAIN just a few weeks before the insurance was taken out.

It smells of trying to get cover after the event. It may not be that as I said. However, that is what it looks like and even if he didnt mean it to, you cannot get insurance after the event. Its too late. He needed to be covered before Feb 08.

Dunsonh, I would like to STRESS that this certainley is NOT a matter of trying to insure "after the event" as you suggest, there are Honest people out here you know, why are you trying to imply that it is? I take offense to you suggesting this.
He took the loan out for a car and they took the insurance out due to the current climate and if he lost his job he would be covered!

pedro123456

Thanks Wendy so now lets go back from now to Feb 08. if I get contradicted by such as dacouch, truegrit or a couple other names who’s opinion I value we will have a rethink

8- His wife would have IMO spoke to a junior staff member, and even if it wasn’t a junior member I cant see how they could verbally refuse a claim, unless of course it is more of a data protection issue, i.e his wife could have been anyone who had access to his policy etc.
If this is the case, written confirmation of his condition and inability to VERBALLY communicate, and also a letter confirming he wants his wife (or anyone else CAB, solicitor etc) to ACT on his behalf signed by his should suffice. However, IC’s are big places, so

A-Ask his wife to ring them again, and establish a contact name (possibly a claims handler) and preferably a direct contact number, and postal address for claims, she doesn’t need to discuss any claim details over the phone
B- Ask her to also inform the IC (name person) that she will be forwarding the request to act letter, and they may have and send their own later or before.
………………………………………………………………………………………………….
7- The IC cannot presume this, they will try so that they put him off claiming.
…………………………………………………………………………………………………
6- Answered in 8
………………………………………………………………………………………………….
1-2-3-4-5- will be answered as a whole, and it aint straight forward by any means, one way or the other, there are both sides of the coin to look at, but hopefully some of what I say may be useful (fingers crossed) anyway give me a while to get back to you, it will be today but aint sure when.


ps you dont have to explain yourself to dunstonh, he has his supporters though and maybe they see something I dont, I have been around for a couple of months, and most the time i find his post unhelpful despite at times apparent factual content, but thats up to them and him !!

pedro123456

And what does he mean by this statement "Remember that it is not diagnosis or medication or outcome that matters. Its the point the condition first became aware. That is in Feb 08. Nine months before cover started"

inparticular this "Its the point the condition first became aware" is this a insurance criteria /statement or something anyone have ideas ?

dunstonh

Dunsonh, I would like to STRESS that this certainley is NOT a matter of trying to insure "after the event" as you suggest, there are Honest people out here you know, why are you trying to imply that it is? I take offense to you suggesting this.

Read what I said again. I made it clear that I didnt imply anything and didnt suggest that was the case. However, making a claim just weeks after taking a policy it will automatically put an insurer on guard that it is a fraudulent claim. In this case it is correct they reject the claim as it is a pre-existing condition that was already under investigation from the doctor at least 10 months earlier and a follow-up a month earlier.

He took the loan out for a car and they took the insurance out due to the current climate and if he lost his job he would be covered!

And that is what he has got. An insurance to cover him for unexpected events. Not events that are already known about.

pedro123456

1-2-3-4-5

The fact that he took out the cover while he was attending the GP will no doubt, influence the thought process of the IC, as not only are they suspicious by nature, the don’t like paying claims for obvious reasons, however there is a element of apparent fraudulent claims about. And although I understand how fraudulent claims are wrong and that some individuals do “fiddle” their system. I fail to see how this could generally be the case if individuals with a serious- life threatening or possible terminal illness could be perceived to be dishonest and or part of these fraudulent statistics.

Nonetheless, he will be treated with suspicion as opposed to and before empathetically.

So we may eventually have to present a case to the IC, but first of course the IC have to dispute and refuse his claim, and that should be the first port of call, so ask your friend to do 8-6. In the meantime consider a few thoughts of mine at this stage.

As far as I can see, he didn’t take out the policy because he had some “premonition” or “foresight” that he had cancer, as clearly this isn’t possible, how many times do individuals go(or don’t go more often then not) to the GP with similar things, and it turns out to be a ear infection, throat infection, swollen glands, tooth abscess, or it was related to a “bug” that was ding the rounds etc.
And in any case that was nearly a year earlier.

The policy was taken out in good faith and that coincidental events took place however they were just that “coincidental”, and of course very sad and unfortunate (for your friend)..

The IC see every thing in black/white, right/wrong when it suits them, they have no emotional, ethical moral view point about a claim, none whatsoever.
Which is somewhat hypocritical considering how the IC exploit customer emotions when SELLING policies.
It’s this short term gain manipulative mentality that underpins the Insurance Industry strategy to maximise profits at any cost IMO, and the ABI don’t see the long term negative effect it is GOING to have on the Insurance Business, but that’s another subject.

Anyway lets look at some facts.

Jan 08 ear infection, given Antibiotics.

November 08 not totally cleared up so back to GP

Dec 08 took out a loan for + PPI because as rightly pointed out employment issues (just like many others have employment issues), when taking out this PPI, he wasn’t asked any medical questions, either PMA (past Medical History) or any present relevant/possible medical question.
So how does the question of a PEMC enter the discussion before a claim has ever been put in?

This PPI was take while still under care of GP, who was considering further investigations, at this time there was nothing to suggest that the earlier ear infection was in anyway connected to the eventual diagnosis, by his GP (who is after all qualified to discuss relevance and definition of a PEMC)

This ear problem swelling IMO couldn’t possibly be defined as a Pre Existing Medical Condition, and therefore (even if asked ) the claimant could not have declared it as a PEMC.
Of course ON REFLECTION it may well have been a sign/symptom, but thats all it aint a PEMC, furthermore your friend isn’t a doctor, the idea of his “thought ear ache or a swelling to his neck” may well be cancer of the mouth is ludicrous to be remotely suggested.

No one in the world would convince me that a fella had a suspicion of a cancer and/or any other life threatening illness, would go out buy a car and get PPI just in case, that’s a idiotic suggestion.
Id bet my last pound that the PPI was suggested to him, and for my money if the IC's are willing to take his preminums every month without, asking/checking PMH or Present Medical History, and the salesman is happy to collect the a little earner by way of a commission, they must accept these co insidence will occur, and the IC should be willing to play the game and pay out.

It was insurance for a car for goodnes sake, if he had wanted to defraud the IC, he would have bought a 100,000 life cover policy as well.

Anyway do as advised unless otherwise said, and we will take it from there.

Also consider CAB, and consider Solicitors and or claims experts.

Thanks Wendy we will talk soon (hopefully) send private message if posting in public is bothering you.



Pete

pedro123456

Wendy could you please let us know who the PPI is with?

wendy_

pedro123456 wrote: »

Wendy could you please let us know who the PPI is with?

Thanks Pedro

I will contact my my friend and get further details of the company, it may be early next week before I get back to you. Many thanks once again for the time you are taking on this matter

dunstonh

Remember that you have to look at the facts of the case and there is one simple fact that cannot be got round. He had the condition before he took the insurance policy out. It doesnt matter that he didnt know what the problem was called. The condition existed before.

You cannot insure yourself for something that has already happened.

Thanks Pedro

I will contact my my friend and get further details of the company, it may be early next week before I get back to you. Many thanks once again for the time you are taking on this matter

Pedro is the forum troll. You may thank him but his posts are mostly incorrect and full of bs. Still, you appear to want to listen to what suits you and ignore everything else. So, you probably are best listening to pedro.

RobertoMoir

dunstonh wrote: »

Not really. Take pedro's posts out (which many of us here cant see anyway as he is on ignore) and you have a pretty normal thread.

I didn't realise you could ignore people on this forum. You're right, this thread makes so much more sense now, and a few others soon will too. Thanks Dunstonh!