UnumProvident

wendykearney

Has anyone else had dealing with these "people" (being polite!)

I had to take them to the Insurance Ombudsman 2 yrs ago to make them pay out. Now its got to the 2 yr mark they are playing silly !!!!!!s again. They have canceled my claim saying i'm well enough to work...

I can disprove this and am well aware i'm in for a fight. Luckily i've my consultant on my side and luckily enough had a medical for my disability and care claim in march which also found in my favour ( i got the care part witout asking for it!)

any advise etc anyonme can give me is much appreciated. I do know somewhere in the country there is a Barrister who specialises in taking these Lice to court but i don't know is name...


Thanks

Astaroth

The ombusman is the best bet to be honest - get a final response from the company and if you arent happy with it then got to the FOS. If the FOS rule against you it doesnt stop you then issuing court proceedings.

dunstonh

unumprovident Income Protection offerings were usually budget versions. This made them quite cheap on premiums but almost a waste of money on what it covered and how you qualified.

I wouldnt touch them at all for income protection. Although that sort of hindsight doesnt do you much good now.

The complaints process needs to be followed as Astaroth says.

wendykearney

It was part of my employees package. Luckily i have medical evidence to support me but last time it took 18mths to get anywhere. They are using out of date medical evidence, a report from their physio the ombudsman said wasn't worth th epaper its written on and a video taken when i was following the consultants wishes whilst doped up 6 painkillers every 4 hrs. Funnily enough 4 days after this video was taken i was examined by DHss Doc who gave me high mobility and low care! I'm using the data protection act to force them into giving me a copy but i've no worries as i know exactly what i can and can't do and have been honest when telling them! My works insurers will not allow me to work because of my mobility and the amount of painkillers i take...

If i don't get anywhere with appealing (and this is likely) i'll of course go to ombudsman again but the internet is full of copies of questions about this firm in Parliment. There is even the Company's handbook on the web telling them how to ignore medical reports etc and to dismiss claims!

Surely this is fraud?
wendy

Astaroth

It isnt fraud to dismiss claims or dispute medical evidence.

Insurers ultimately dont want to pay out claims - many claims cost a lot more money than the insured will ever pay to the company. Insurers may have all sorts of slogans in their claims departments like "tough but fair" but ultimately if they think they dont have to pay a claim they arent going to do so out of the goodness of their hearts... if they did they either have to massively increase premiums or the shareholders will remove the board of directors.

Whilst people from outside the 2 sides of the industry (particularly with the likes of PI claims) may find this kind of practice distateful it is understandable. In PI claims which is an easier example, the solicitor will want a doctor that is known to over state injuries and be very cautions on the prognosis where as the insurer will want a doctor who says all they need is a plaster and a good nights sleep. This is known by both sides and people are trained appropriately to argue against the other side which does mean you get handbooks like you mention.

I never worked in creditor/ health etc claims but the missus did. I am not commenting on your personal case but there are a lot of doctors out there that are more than happy to put what ever their customers want on the forms - some dont ignore a small trade of services/ money for this either.

wendykearney

Thanks to my consultant there are internal pictures of my ankle that back me up, surly at the end of the day medical opinion not someone with a clerical background should assess claims? One of the reports they are using is from 2002 and has already been discredited!

I won't back off and will take it to the ombudsman as well as my Mp if necessary. I think they rely on you backing down, which isn't going to happen.

wendy

Astaroth

Certainly where the missus worked they had a doctor on the staff who actually reviewed all the medical evidence supplied for claims over X months or £y value. In addition to the doctor there was also a company of medical experts that the doctor could refer cases onto when it was beyond his scope of knowledge.

In personal injuries we didnt have a doctor but we did have the same firm of medical experts to refer cases to who would come back with comments/ suggestions/ further questions to ask.

Therefore it wasnt a clerical/ claims technition that actually made recommendations on if to accept or decline the claim. The claims handlers then simply apply the company rules to the recommendation. In her case it was normally accepting claims which the policy states arent covered due to previous FOS ruling etc.

Given the FOS charge a significant amount of money (£300-1000 depending on the company) for each case it looks into, irrespective of if they rule in favour of the customer or the insurer, insurers tend to be tough but arent silly about these things as continuous FOS fees can out weigh the cost of paying claims.

mattymoo

Surely the 2002 report was available at the time the ombudsman made a ruling in your favour. Is this the report which he said "isn't worth the paper" etc.

If so, surely you can simply refer them to the ombudsmans decision and suggest that unless they want to go down the same route again, they reconsider in your favour.

No direct experience of this type of claim but like Astoroth I used to deal with Third Party Personal Injury Litigation. To explain, you have a contract with these people so you are 1st party, they are second party. With third party, it is someone else, outside the contact, who is sueing, e.g. employee or a motorist / pedestrian you injure.

Now with TPPI, if you have video evidence of someone in good health when they claim to be otherwise, you have to provide a copy to that person. Much like the police have to give the defence access to the evidence and statements.

Not sure if this still holds true in 1st / 2nd party actions like yours but I would suspect it does. The rule for TPPI is in place because judges do not take kindly to the production of last minute evidence - videos for instance.

In your letter, ask them if they intend to rely upon the video evidence and if so, they must provide you with an unedited copy by way of disclosure.

posh_totty

Hello Wendy.
You have my sympathy.

I am also having problems with UnumProvident and on the verge of going to the Ombudsman. They have been difficult throughout my PHI claim and are currently refusing to recommence payments to me, even though my consultant keeps telling them I am unable to return to my occupation.

Regards, Posh Totty

lowis

have read with interest...just been advised to take a UNUM policy by an Endsleigh advisor...i will avoid it like the plague!!! hope things work out for you.

now, has anyone got any stories about Norwich Union or Pioneer friendly society?

dunstonh

Lowis, in your other thread i nearly named unum as one of the really poor examples. I'm pleased you found this thread.