GP Records and Critical Illness

happypearl

I have recently made a claim on our critical illness insurance and am certain the nature of the illness qualifies for a payment. When I took out the cover I honestly answered that I had not smoked in the previous 12 months - I know the exact date I stopped as it was pregnancy related. The insurers have now written to tell me the GP has informed them that I was an occasional smoker in the year following the one in which I gave up (which could or could not overlap with the 12 months prior to taking out insurance). I am quite clear of my dates and do not know why I could possibly have said to the GP otherwise and don't recall ever having a conversation with them. How can I contest what the GP has said? It would seem to be a matter of their word against mine!

dunstonh

Even if you were a smoker, it would be unlikely to result in a refusal of claim. The most likely outcome if they dont back down on that is they pay the claim (assuming thats ok) and deduct the extra cost for being a smoker that you would have paid had you declared it.

You should put your case forward to the insurers. You can also ask for a copy of the GP details as clearly they are saying something you disagree with.

Did you go to the GP or any clinic afterwards to obtain help on giving up smoking?

happypearl

No - I have never requested any help or needed patches or anything. The news of our pregnancy was enough! I go to the GP so rarely that I have no idea at what point they would have been aware that I had stopped smoking. The insurers have said that the GP said I was an occasional smoker until fairly recently but when I spoke to the practice, they say that they didn't, but that they did say I gave up smoking the year after I actually did. I don't feel I can possibly respond until I know exactly what the GP said but don't know whether I have a right to see what they sent the insurance company.

dunstonh

don't know whether I have a right to see what they sent the insurance company.

Yes you do have a right. You can either ask the doctor or you can ask the insurance company. I would try the GP first.

happypearl

Now have report from GP which makes no mention of being an occasional smoker but notes I stopped in 2003. Why would the insurance company be telling me that the GP said something that they patently haven't? Curiouser and curiouser!! Have sent all required info re smoking history and will see what happens next. Predictions?!

dunstonh

Did your notes include the response the GP gave to the insurer?

happypearl

Yes - the GP is adamant that they did not send my records but completed the form they were sent (of which I have been given a copy). The insurance company had said that the doc said I was a smoker in Oct 2008 (which I wasn't) but there is absolutely no mention of this in the report. 'Tis very odd!!

starrystarry

Hi happypearl, don't know whether this will be of any help to you.

Quite often GPs complete the form that insurance companies send out and send a computer printout summary of your records along with it. These computer printouts usually have a section re smoking, so it might have been on that. The insurance company will be able to tell you exactly which part of the report they got the info from, i.e. the handwritten form the GP completed or from a printout.

dunstonh

It could be poor writing quality that they have read the 3 as an 8 in the year?

Whatever the error, the fact it doesnt say what the insurance company think it said works in your favour.

lindos90

dunstonh wrote: »

It could be poor writing quality that they have read the 3 as an 8 in the year?

Whatever the error, the fact it doesnt say what the insurance company think it said works in your favour.

yep, just what I was thinking, either poor handwriting, or a typing error. Contact your insurance company and tell them you have a copy of the letter, with the correct dates, and see what they say.

happypearl

Can anyone offer their thoughts on, what is turning out to be, a rather complex situation.

There has been some progress with the CI claim I have had a call from the claim handler to say that they have agreed that my condition meets the criteria for critical illness. She then went on to talk about a different policy that I took out in 2001 - a Mortgage Term Assurance - that we increased 2003 . When we took out the claim in 2001 we were down as non-smokers so she wants to know why, in the smoking history I provided regarding the CI claim l said that he was still having 5 - 10 fags a day between 2000 and 2002. I was a bit surprised that they had asked for information about this period as it did not relate to the time we took out the CI cover so I feel I have been misled.

I explained that dates I gave in response to their query were as accurate as they could be and pointed out that I am unable to remember many of the specifics as it was so long ago and that I had make various attempts at stopping smoking which could have been at any point and lasted upwards of a year. I applied for insurance through an IFA who wase always been very clear with us about questions and that I cannot see that I would ever have lied - therefore, in 2001 I would have answered whatever questions I was asked in an honest way. They seem to accept that I had stopped smoking well before taking out the CI cover in 2004.

The Claim Handler now going back to the GP's to see if there are any more details in the medical history. It would seem that I am OK with the info provided re critical illness cover and she implied that I will be payed but suggested that they would be adjusting the life insurance policy to be as if we had been smokers depending on what the GP says.

I do not understand what the implications of this are and whether I should have said it is ok for her to speak to the doctors again when it concerns a different policy. She plans to ring them on Monday: should we try and put a stop to this as I am a bit concerned that she may have lulled me into some sort of "trap".

Having spoken to the GP she said it would then go to a panel, who would make a decision and she would sort out a payment.

Again, I am sure I would have answered any questions honestly but before my current condition occurred i was a very infrequent visitor to the doctor and would have no way of providing evidence to counter any records they have, whether inaccurate or not!

In the worst case scenario, and for some reason the GP has recorded that I was smoking at the time when I took out the Mortgage Term Assurance, what might happen?