Help - My critical insurance claim

Molly41

Hi,
If any of you kind folks out there would help me it would be much appreciated.

I have a claim being assessed at the moment for occupational definition of Total Permanent Disablement. I am a midwife.

I was somewhat shocked to find out that the insurers have requested all my medical records back to the year dot! Are they able to do this? There is some very personal info not pertaining to the claim, subsequent to commencement of the claim that I have not shared with anyone. Is there anything i can do about this or just admit defeat gracefully? I am waiting to speak to doctors secretary regarding this info but she not around until tomorow.

I have also reviewed the original application form for the claim and its really badly worded with very scant information on it. I did not disclose one of my original conditions because I was not asked about it anywhere. In reality its a very benign condition and very rarely causes problems - my case being extreme and an exception. I also suffered from a one-off bout of dizziness prior to the commencement of the claim....described as giddiness on the claim form. I did not disclose it for whatever reason...didnot think it was important or forgot about it. I disclosed lots of other things and hence my premiums for all these years have been hefty. However, now, my main problem relates to a loss of balance and falls. So I think they are gonna decline it. Please what do you think?

Thanks,
Molly

dunstonh

I was somewhat shocked to find out that the insurers have requested all my medical records back to the year dot! Are they able to do this?

In the event of a claim and the information being required, then yes they are. You do sign paperwork to allow them to do this. However, you are allowed the information to be supplied to you first.

If you start witholding your medical information then the insurance company will start thinking the worst about you.

I did not disclose one of my original conditions because I was not asked about it anywhere.

Thats fine. If its not asked for and does not form part of the "catchall" question that is usually asked about other things in the last 5 years then you have nothing to fear.

I also suffered from a one-off bout of dizziness prior to the commencement of the claim....described as giddiness on the claim form. I did not disclose it for whatever reason...didnot think it was important or forgot about it.

If that turns out to be related to the claim now then it will almost certainly be an issue. If it was something that was under investigation at the time of the application then it could work against you as well as typically insurers will not take on business whilst investigations and tests are outstanding.

However, now, my main problem relates to a loss of balance and falls. So I think they are gonna decline it.

You need to prepare yourself as there is the possibility. Your GP records are going to show the previous non-disclosed event and as the claim looks like its in a similar area (guessing only from what you say), then this does look like a case of non-disclosure. If the insurance company feel the same way then they have to decide whether its intentional non-disclosure or accidental non-disclosure.

Astaroth

It is common practice for insurers to ask for complete medical history. Whilst I am sure most Doctors are very professional there is the double issue of firstly if your current GP has read your full X years of medical history or not, I know for a fact mine hasnt, and secondly if the GP will be biased towards their patient they have known for years or the faceless insurance company that makes millions a year in profit and makes peoples lives hell by declining claims.

Obviously dont know what embarassing condition you dont want others to know about but in all my years of receiving medical reports and GP records I can only remember 1 case where it ever stuck out (and there were plenty of impotence cases, incontinence etc) as anything "amusing" etc and there were very tight procedures in place to ensure that you didnt go down the pub and start chatting about the medical report you received for Mr Smith and how they had impotence and genital warts and how did they catch them if they cant get it up in the first place etc.

To be honest, after you have read so many of the damned things, its simply boring reading them and you really are just scanning for anything potentially relevant... same way as toilet humour does eventually stop being funny after the 50th time of hearing the same joke.

Molly41

Dunstonh,
Thanks for taking the time to respond. I know you have responded in the past and its much appreciated.
At the time of completing the medical form my condition was a one-off and I did not think it would ever come back to haunt me let alone completely disable me. It was not intentional at all on my part and again its a very benign condition for most people. I am really surprised about the lack of information requested on the original application form...I have done medical forms for my job and they were pages long. Have you suffered from this...for pages. This one asked six questions. How do the claims people decide it was intentional or not?

Im more or less decided that they will decline it anyway. I was in floods earlier cos of it and thought perhaps i should just cancel the claim and save the heartache... life is just not fair but then my fighting spirit emerged.....again....

I have just spoken to the doctors and they were very understanding of my concerns. I am going in to go through all the papers that have been requested.

Mollyx

Molly41

Astaroth wrote: »

It is common practice for insurers to ask for complete medical history. Whilst I am sure most Doctors are very professional there is the double issue of firstly if your current GP has read your full X years of medical history or not, I know for a fact mine hasnt, and secondly if the GP will be biased towards their patient they have known for years or the faceless insurance company that makes millions a year in profit and makes peoples lives hell by declining claims.

Obviously dont know what embarassing condition you dont want others to know about but in all my years of receiving medical reports and GP records I can only remember 1 case where it ever stuck out (and there were plenty of impotence cases, incontinence etc) as anything "amusing" etc and there were very tight procedures in place to ensure that you didnt go down the pub and start chatting about the medical report you received for Mr Smith and how they had impotence and genital warts and how did they catch them if they cant get it up in the first place etc.

Its not so much embarrasing (im a midwife..I dont embarrass easily) but very personal stuff. I have spoken to the health insurers..they have assured me that info is safe but its just not relevant to the claim. It feels demeaning that someone should be picking through my medical history with a fine tooth comb. I understand they have to make a fair assessment but Im worried about the safety of my medical information. I mean it gets sent through the post...that in itself worries me enormously. I understand a lot about confidentiality of info as Im a midwife...i used to eat, sleep, breathe it...that why I dont understand why I dont have more rights regarding this.

Astaroth

Realistically, it will be sent through the post to the insurer. They will store it in locked filing cabinates in a building with strict entrance security (have had nore than 1 knife carrying claimant removed from reception before) under a claims reference ID or the documents will be scanned, encrypted and stored securely on a server (similar as to all our medical records will be shortly).

Once the paper document is no longer required on site it will be sent to a records management company like Iron Mountain (who I believe also have NHS contracts) where it will live for up to 7 years before being incinerated.

From a corporate perspective I have sent much more sensitive documents than medical records to companies like Iron Mountain. Whilst it may be embarassing for your medical history to get out things like the 10 year strategy of a company etc is going to be much more valuable if there was a security risk and certainly blue chip clients I have worked with have considered it secure enough to store such documents there and not fear a rogue employee there selling them to the highest bidder of competitors and newspapers etc.

pedro123456

Molly.

Are they entitled to your Full Medical Records?, I don’t think so see section 4 of these joint ABI-BMA guidelines. PRINT THESE GUIDELINES OUT AND GIVE THEM TO THE GP PRACTICE

http://www.abi.org.uk/Information/Co..._Notes/527.pdf

Disclosure non-disclosure, look here

http://www.abi.org.uk/Information/Co...otes/40737.pdf

What is TPD now there’s a question, I would like the Insurance bods to try and cast some light on that one……..but they wont, anyway look here see section 6

http://www.abi.org.uk/Information/Co..._Notes/532.pdf

Good luck, hope all goes well for you.

ylesia

dunstonh wrote: »

Thats fine. If its not asked for and does not form part of the "catchall" question that is usually asked about other things in the last 5 years then you have nothing to fear.

This isn't completely accurate. Although an insurance company has a huge responsibility to make sure there application forms cover everything, there is still a responsibility on the person to disclose any information that they think is relevant. An insurance company can still refuse a claim on the basis of non-disclosure when there is no specific question on the form, it is harder for them to argue but cases have been refused on this basis (I work in insurance).

However, from what you have said, the non-disclosure sounds innocent therefore hopefully won't be a problem but I wouldn't rely on the "it wasn't a question" arguement. The general rule is that anything that pops into your head when filling out a form that you think might be relevant then it is best to disclose.

I know someone who took out life insurance but didn't disclose that she had had deep vein thrombosis during a previous pregnancy as it wasn't specifically asked and there was no "catch-all" question. Sadly she died from complications relating to deep vein thrombosis 3 years later after the birth of her next baby. Her husband has been fighting for over 2 years now to try and get the claim paid

Molly41

pedro123456 wrote: »

Molly.

Are they entitled to your Full Medical Records?, I don’t think so see section 4 of these joint ABI-BMA guidelines. PRINT THESE GUIDELINES OUT AND GIVE THEM TO THE GP PRACTICE

http://www.abi.org.uk/Information/Co..._Notes/527.pdf

Disclosure non-disclosure, look here

http://www.abi.org.uk/Information/Co...otes/40737.pdf

What is TPD now there’s a question, I would like the Insurance bods to try and cast some light on that one……..but they wont, anyway look here see section 6

http://www.abi.org.uk/Information/Co..._Notes/532.pdf

Good luck, hope all goes well for you.

Thankyou so much for that information. Im reading through it now. Much appreciated

Molly41

ylesia wrote: »

I know someone who took out life insurance but didn't disclose that she had had deep vein thrombosis during a previous pregnancy as it wasn't specifically asked and there was no "catch-all" question. Sadly she died from complications relating to deep vein thrombosis 3 years later after the birth of her next baby. Her husband has been fighting for over 2 years now to try and get the claim paid

Oh that so sad. It puts my claim into perspective - Im gonna stop feeling sorry for myself now x