Life Decreasing Assurance

jas65_2

Hi again. The policy states that my wife was not covered for any mental illness on the policy, because she had suffered from depression, but yet she is classed as an Asthmatic, she declared that she smokes on the policy, but yet she was still covered as a smoker. Thats what the indipendant underwriter picked up on. Like I said though. Origionally we didn't even realise my wife was insured until the policy came through, and we hadn't realised we were covered for critical illness. We thought it was for death only to cover the mortgage, I was just browsing through the insurance papers out of curiosity, after my wife had been diagnosed with M.S when I stumbled on the fact that we were covered for critical illness, and M.S was covered on there. Thats when we made a claim. Obviously we're not optomistic of the outcome, but it's worth a try. Also according to the indipendant Underwriter, at no point should the Insurance company have cancelled our life insurance policy, although he doesn't state the reason why.

dunstonh

The policy states that my wife was not covered for any mental illness on the policy, because she had suffered from depression

That is a very common exclusion with people that have suffered from depression.

but yet she is classed as an Asthmatic, she declared that she smokes on the policy, but yet she was still covered as a smoker.

No suprise there either. Smoker rates are higher and being asthmatic doesnt necessarily mean there will be any other issues in future. If she had a history of hospitalisation from it then they would consider rating it or putting in an exclusion.

Thats what the indipendant underwriter picked up on.

He is clutching at straws. All IFAs will tell you that different companies have different approaches on underwriting. You may find one that looks at it one way and another differently.

Also according to the indipendant Underwriter, at no point should the Insurance company have cancelled our life insurance policy, although he doesn't state the reason why.

That is not correct. An insurance company can void a policy if it finds out the application didnt match the circumstances and it would not have offered cover from the start. Typically, if it would offer cover, the redraws dept at the life company would issue revised terms and give you the chance to accept those or not.

Origionally we didn't even realise my wife was insured until the policy came through, and we hadn't realised we were covered for critical illness.

That isnt good but its going to be difficult to prove. The illustration would have confirmed the details. The suitability report/policy confirmation letter would have confirmed the details and the illustration is issued to you again by the provider directly with the cancellation rights. You are going to have to be reliant on the documentation of the seller being not very good. Otherwise it will just end up as your word against theirs and you never know how they will go.

I would imagine that the sellers will also argue that the the depression and asthma were declared so why would they not include any other medical conditions? Typically, where the seller has not asked the questions, the application is submitted on clean health basis. So, this would be an unusual case.

You say you have employed a solicitor. What has the complaints dept at the seller's company given you as an outcome to your complaint? What has the financial ombudsman service ruled?

jas65_2

Hi there again.
We didn't actually go through the Ombudsman. We were umming and arring whether to take this to a Solicitor or not, in the end I think we came to a descision not to, but then a friend of my wife's read through all the paper work, as She used to work in insurance claims, and She seemed to think we had a good case. The next thing my wife's friend rang us, and told us she had made an appointment to see a solicitor that she knew.
I then took all the paper work down with me to show him. Thats when he told me he would take the case on. I told him I was expecting to throw all the paper work in the bin after our meeting. He asked why? I said that obviously they would have all their legal team that would have scrutinised all the paper work and come to their conclusion. He just told me, that he hadn't lost a case yet, and here we are 2 years down the line. P.S We didn't ring their complaints department. Also we have legal expenses cover on our house insurance which is paying for the case.

dunstonh

He just told me, that he hadn't lost a case yet, and here we are 2 years down the line.

Yes the FOS would have dealt with the complaint in about 6-12 months and ruled on a similar basis to how a court would (although the FOS are generally regarded as being slightly more favourable to the consumer than the courts as they look at fairness and not just points of law) and the FOS is free of charge to consumers.

Use of the FOS wouldnt have prevented you going to court either if you didnt agree with the outcome.

jas65_2

Hi dunstonh. Thanks for all the info on the matter in hand. Obviously all this is new to us, and had we known about the FOS, and all the other things you have pointed out, we would be in a different prediciment to where we are at the moment. As they say, we live and learn, and a lesson well and truly learned. We will certaintly be more aware the next time we go for any insurances, if we can get life insurance that is, after all this palava. I haven't tried to get any insurance yet, as I will no doubt have to declare that I have been refused insurance, bumping the premiums up even more. I do have life insurance through work, which is set up by the company, and will cover the cost of my mortgage should anything untoward happen. I will of course let you know the outcome of the ongoing case. Thanks again.

dunstonh

I will of course let you know the outcome of the ongoing case.

Please do as its always nice to know the outcome. Too many threads leave a story unfinished and we never know.

Good luck

danuk

Just reading this when searching about life assurance costs...

What was the outcome ??

sophievenusdoom

starrystarry wrote: »

That's got non-disclosure written all over it.

I'm getting fed up of hearing people say insurance companies will do anything to avoid paying out. I'm going to start countering with "applicants for insurance will do anything to avoid giving honest answers to direct questions".

I have to agree with this. Maybe I am biase as I work for an insurance company, but you do get to see all the nitty gritty things that people do try and hide!

I also concur that this has ND written all over it, but we shall wait to see what the OP comes back with. I am sure there are genuine cases where certain insurance companies do try to wriggle out of paying a claim!

sophievenusdoom

*MF* wrote: »

FWIW ... earlier post from OP elsewhere on MSE provides some more details:

http://forums.moneysavingexpert.com/showpost.html?p=10076695&postcount=2888

Interesting...and I know *some* IFA's do go about things in this way. Maybe the complaint should have been taken up with them instead of the insurance company??

sophievenusdoom

jas65 wrote: »

Hi there, and thanks for all your replies. Although most of them seem negative. They are refusing to pay out for none disclosure. However We answered all the questions that were asked of us, knowing that if We answered incorrectly, this would be picked up when they requested the medical notes.
The Bank asked us if We had Life Insurance, to which We replied no, but We were looking, so they said they would send out an advisor, which they did.
He never offered for us to fill out the form. He just sat there, asked the questions, and We answered the best We could. We were both a bit naive as far as Insurance is concerned, so We thought Him being an expert, He would offer the best advice, and He knew what He was doing. He never offered us any other policies, other than the one We took out, yet according to the Bank, He was able to sell any policy with any company, but when we checked the back of His business card, only a couple of weeks ago, it said He could only sell (the company we ended up with policy's). As We are both smokers, obviously the premiums were very high, so We just told him to insure myself being the main earner. He asked us both to check our names, and Birth dates were correct, then sign. One of the questions He asked was. Has my wife ever been off work with depression. She said yes. I'm off at the moment, and will be back to work next week. He even wrote the medication that she was on down on the form. However, when he sent it in He had ticked no to her having time off work, but there was an exclusion for any mental disorders on the policy anyway, but they still picked up on that when we put a claim in, stating that she had had 4 months off work with depression, and not declared it, and if they had known that, they would have deffered the policy for 12 months.
Untill the insurance form came through, We didn't even think that She had been insured, because He had told us it would be £78 a month for the both of us, thats when we said just insure me for now, but they insured both of us for £33 a month??? and only when the policy came through did We realise who We were insured through, untill then We thought it was the banks own policy.
According to the Guy that visited us from the Bank. He made 2 visits to the house. The second time to do a fact finding form. He never, He only came the once. An indipendant underwriter has said that if he was the underwiter for the insurance firm. He would have requested to see further medical evidence from the Hospital due to the fact that my Wife had, had depression, so would have noticed that she had been off work.
He also finds it amazing that the insurance company had put on a disclosure for mental illness, but not for smoking, as an Asthmatic smoker.

This is what is known in the business as a "tied adviser". He can only sell the products for the company that he represents.

I know the insurance company that I work for would have seen that there was a disclosure on the app regarding depression/meds and would have asked further questions either from your wife by way of a telephone call, or from her GP. If they did not pick this up, I think to a certain extent they might well be liable. Keep us posted