Critical Illness Advice pls?

quietheart

I've had a critical illness claim rejected as I don't fit their criteria for the condition (stroke). I have now accepted this but as I cannot get additional cover I asked them to increase my cover. They have written to me today saying they won't cover but also that looking at my gp notes they've noticed I didn't declare back pain on the form.
We used an IFA who has now left the industry due to stress. Wen he ran through the health questions we answered everything honestly and talked to him about what was relevant, I said I'd had back pain but nothing serious, he deemed to tick the no box and we mistakenly trusted that he knew/understood and his judgement was better than ours.
So now I have to speak to them tomorrow about my 'non-disclosure'.
Can they cancel the policy because of this or would it just be relevant if I tried to claim with a back related problem in the future?
I'm so fed up of this situation.

starrystarry

Hi quietheart,

They can void your policy altogether if they choose to, or they might offer you alternative terms with an exclusion so that you couldn't claim for anything related to your back. It's unlikely they'll leave the policy unchanged and just wait to see if you to claim for something related to your back, as they would weaken their position on the non-disclosure by finding out about it now and not doing anything.

You have no redress against the insurance company as you signed the proposal form to say the answers to all the questions were correct. You could, possibly, have a case against the IFA but that would be nigh on impossible to pursue if he's left the industry.

I'd suggest you be honest with the insurance company when you speak to them tomorrow. They're probably not ogres! And I know you're fed up about it but please don't get angry with the insurance company. Remember, they've done nothing wrong.

quietheart

Thanks. I'm going to be honest of course, I'm worried about being left with no cover at all so hoping they go for the back exclusion.
As for the IFA, we're still on the company's books so I'd want to complain to them but realise it's probably futile.
I am mad with the insurance company though, it's all on their terms, they won't pay out, they won't cover me and now they're looking for more get-out clauses. I'm no fan.
I wish it had been explained to me that critical illness isn't just about cancer/stroke etc, my back pain was an inconvenience but didn't stop me doing anything. They have also asked why I didn't mention it since taking out the policy, I honestly didn't consider letting them know I didn't know I should.
Hope tomorrow is a better day;).

ACG

they are unlikely to cancel your policy if it was a minor problem a few years back. They may put a back or lower back exclusion on there but i cant imagine it would be anything more than that as a back problem and stroke are unrelated.

They may also increase your premium or reduce your cover so to keep the premium the same.

pedro123456

Quietheart, it’s a mystery isn’t it, how your GP and possibly Medical Consultant can diagnose that you have had a stroke, but the IC can refute it, because you didn’t meet THEIR criteria or definition. I’m afraid its just the slippery, underhanded way in which IC work.

As for looking at the GP notes and joint guidelines between the IC bodyguards (ABI) and the BMA indicate the IC are only entitled to RELEVANT Past Medical History, and the your GP should only provide them with relevant history. Your IC has no business asking for your full medical history and you GP has no business supplying your FMH.

Have a look at section 4……………….. BMA/ABI guidelines

Only relevant information should be provided and it is ethically unacceptable to provide extraneous
information. Doctors must not send originals, photocopies or printouts of full medical records

http://www.bma.org.uk/images/MedicalInfoInsurance_tcm41-173470.pdf

Will they cancel the policy? Why should they?
They are taking your premiums, and although you have had a stroke they haven’t paid out, its my guess they will just keep taking your premiums, time will tell.

Anyway complain about your GP divulging irrelevant PMH to your IC, and complain to the IC for requesting them and accepting them.

quietheart

pedro123456 wrote: »

As for looking at the GP notes and joint guidelines between the IC bodyguards (ABI) and the BMA indicate the IC are only entitled to RELEVANT Past Medical History, and the your GP should only provide them with relevant history. Your IC has no business asking for your full medical history and you GP has no business supplying your FMH.

Have a look at section 4……………….. BMA/ABI guidelines

Only relevant information should be provided and it is ethically unacceptable to provide extraneous
information. Doctors must not send originals, photocopies or printouts of full medical records

http://www.bma.org.uk/images/MedicalInfoInsurance_tcm41-173470.pdf

Anyway complain about your GP divulging irrelevant PMH to your IC, and complain to the IC for requesting them and accepting them.

:eek: Really?! The cheeky flippin monkies. I'm going on holiday tomorrow but will look into complaining when I get back. I'm wondering if I agreed to them checking medical records when I put the claim in, but if the guidelines are as you said, it shouldn't have been requested. I'm very interested in your point.
I've spoken to Friends Provident (who I wouldn't recommend to anyone) and they are cancelling my policy and reinstating it with a back clause.
I was really upset that they'd had my full medical records and asked him to send me a copy which, of course, he isn't going to do. I'm unhappy that he knows what's in my notes and I don't!
Thanks for the input, it's a huge help when people know what they are talking about (unlike me....)
:T

starrystarry

pedro123456 wrote: »

Quietheart, it’s a mystery isn’t it, how your GP and possibly Medical Consultant can diagnose that you have had a stroke, but the IC can refute it, because you didn’t meet THEIR criteria or definition. I’m afraid its just the slippery, underhanded way in which IC work.

As for looking at the GP notes and joint guidelines between the IC bodyguards (ABI) and the BMA indicate the IC are only entitled to RELEVANT Past Medical History, and the your GP should only provide them with relevant history. Your IC has no business asking for your full medical history and you GP has no business supplying your FMH.

Have a look at section 4……………….. BMA/ABI guidelines

Only relevant information should be provided and it is ethically unacceptable to provide extraneous
information. Doctors must not send originals, photocopies or printouts of full medical records

http://www.bma.org.uk/images/MedicalInfoInsurance_tcm41-173470.pdf

Will they cancel the policy? Why should they?
They are taking your premiums, and although you have had a stroke they haven’t paid out, its my guess they will just keep taking your premiums, time will tell.

Anyway complain about your GP divulging irrelevant PMH to your IC, and complain to the IC for requesting them and accepting them.

Pedro, you're only partly correct there. The insurance company should not ask for quietheart's full medical records and I can guarantee that they won't have. Quite often though the GP can't be bothered to fill in the questionnaire that the IC will have sent him/her, so they just send a photocopy of the full medical records (or sometimes even the originals, believe it or not). The GP is not allowed to do this, unless they get specific consent from their patient to do so, which clearly in this case they haven't. If the GP has done this, then the IC has done nothing, they have no way of knowing whether the GP has got the consent from the patient.

Back pain is relevant to a critical illness policy by the way, as many of these policies cover total/permanent disability as well.

The IC will have spelled out what the "definition" of a stroke was in the policy conditions that quietheart accepted. So again, they've done nothing wrong by rejecting a claim that doesn't fit the criteria.

pedro123456

Starystary, thanks for your input, you say I am “partly right” and therefore the suggestion is that I am “partly wrong”, can you explain why I am “partly wrong” what part of my reply is wrong.

Also can I ask what relevance “back pain” has to do with a claim for a stroke (CVA) the OP wasn’t claiming for a TPD, was he?

If you are trying to absolve the IC of any blame in not following the joint ABI/BMA guidelines forget it, you are misguided, as stated “they should not ask or request” and therefore they surly have no business referring to them and/or refute a claim based on them, correct?

But to be fair this practice will only get stopped if the GP’s are made to answer for it, the public have to complain in order to promote these guidelines, for a fact it suits the IC, but in reality the public have to take the complaint higher than their local complaints procedure in order for it to have any real impact.

The fact that queitheart purchased CI cover for his/her rainy day in case of future illness only to be told that the “stroke” he suffered (as diagnosed by possibly GP and or Medical Consultant), wasn’t a “all singing all dancing Insurance stroke” and therefore not a proper stroke, or a valid claim, is to say the least disgraceful.

Would he, or many other, purchasing CI have any idea that the IC definition and/or criteria is different to the medical definition without medical knowledge?.............. I doubt it.

My thought is that he paid his/her premiums every month in case he had a rainy day, and when the rainy day came his brolly was full of holes, loopholes !!

ps , IMO from the little that has been said, there may be some grounds to appeal this.

Phlip_corter

All Information are incredible and helpful to me, I really have been reading every post carefully and i am grateful to you all here.

starrystarry

pedro123456 wrote: »

Starystary, thanks for your input, you say I am “partly right” and therefore the suggestion is that I am “partly wrong”, can you explain why I am “partly wrong” what part of my reply is wrong.

Also can I ask what relevance “back pain” has to do with a claim for a stroke (CVA) the OP wasn’t claiming for a TPD, was he?

If you are trying to absolve the IC of any blame in not following the joint ABI/BMA guidelines forget it, you are misguided, as stated “they should not ask or request” and therefore they surly have no business referring to them and/or refute a claim based on them, correct?

But to be fair this practice will only get stopped if the GP’s are made to answer for it, the public have to complain in order to promote these guidelines, for a fact it suits the IC, but in reality the public have to take the complaint higher than their local complaints procedure in order for it to have any real impact.

The fact that queitheart purchased CI cover for his/her rainy day in case of future illness only to be told that the “stroke” he suffered (as diagnosed by possibly GP and or Medical Consultant), wasn’t a “all singing all dancing Insurance stroke” and therefore not a proper stroke, or a valid claim, is to say the least disgraceful.

Would he, or many other, purchasing CI have any idea that the IC definition and/or criteria is different to the medical definition without medical knowledge?.............. I doubt it.

My thought is that he paid his/her premiums every month in case he had a rainy day, and when the rainy day came his brolly was full of holes, loopholes !!

ps , IMO from the little that has been said, there may be some grounds to appeal this.

You're partly wrong because you said the OP should complain to IC for requesting and accepting full medical notes. The IC will not have requested full medical notes as they're not allowed to. If the GP sent them to the IC, the IC had no way of knowing whether the GP had got specific consent from the patient. That's between the GP and the patient, nothing to do with the IC. Given that the GP should only send them if they've got the relevant consent, is it not reasonable for the IC to assume that the GP did what he/she was supposed to do? You can't really blame the IC for something that the GP should have done.

All ICs make it clear to customers what the definitions of the listed critical illnesses are before the policy is taken out. If a customer doesn't understand the definition then there's nothing to stop them asking the IC to explain it. I often explain things like this to customers. Or the customer could ask their GP to explain it. Or they could choose not to take the policy. Regardless, it's not the ICs fault that the customer took the policy out without understanding (or bothering to read) the terms and conditions.

You asked "what relevance “back pain” has to do with a claim for a stroke (CVA) the OP wasn’t claiming for a TPD, was he?". The answer is that back pain does have nothing to do with a stroke and the OP wasn't claiming for TPD. The OP tried to claim for a stroke but didn't meet the criteria for a stroke. The claim was declined for this reason, nothing to do with the back pain. In the course of assessing the claim the IC found out about the back pain that wasn't disclosed so they have taken action to apply an exclusion the policy.

badger247

I wonder is a complaint to the Financial Ombudsman would result in your non-disclosure being deemed "innocent"?