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Critical Illness - A Dreadful Experience with Scottish Provident

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Critical Illness - A Dreadful Experience with Scottish Provident

edited 23 March 2010 at 5:01PM in Insurance & Life Assurance
36 replies 24.6K views
ellie43ellie43 Forumite
446 posts
edited 23 March 2010 at 5:01PM in Insurance & Life Assurance
I have read with interest the threads concerning critical illness.

If you are considering taking out CI cover you may wish to bear in mind my experience. My policy is 'own occupation'.

I first became ill in 1999 when I did not fully recover from a bout of flu. I was initially given a 'working diagnosis' of depression, undertook graded exercise therapy (GET), cognitive behavioural therapy (CBT) and was prescribed 6 different anti-depressants. As early as 2001 my GP notes indicate that ME/CFS was suspected. Also I reduced my hours at work to 20 hours a week, but my symptoms of physical and cognitive fatigue worsened. By April 2004 I was too unwell to work at all. In June 2004 I saw a NHS Clinical Champion with over 20 years experience who diagnosed severe ME/CFS and stated that it was very unlikely that I would be able to work again. In June 2005 I was awarded Ill Health Retirement as a result of the disabling effects of ME/CFS.

In the Autumn of 2004 I made a claim under my critical illness policy with Scottish Provident. This was the start of a nightmare lasting over 5 years. SP sent a psychiatrist to 'assess' me who diagnosed depression, even though he said in his report I was not depressed when he 'assessed' me. This psychiatrist has claimed training in the field of ME/CFS but when repeatedly asked where this training was undertaken has refused to respond. This psychiatrist recommended concurrent CBT/GET and further antidepressant therapy.

By coincidence NICE recommend CBT/GET for people with ME/CFS, but not for those severely affected by the illness. My claim was refused on the grounds I had not had 'optimal treatment of CBT/GET', delivered by an appropriately trained therapist. It should be borne in mind:
1) That there are no such ME/CFS therapists in my region East Anglia, privately or on the NHS
2) Even if there were I am not well enough to travel to access and participate in the therapy
2) My ME/CFS NHS medical team did not recommend further CBT/GET in my case.

Scottish Provident repeatedly refused to tell me what in their opinion my diagnosis is and what medical evidence they would accept in support of my claim. I asked them that in order to satisfy the policy would I have to undertake further CBT/GET by a therapist specialising in depression and also CBT/GET by a therapist specialising in ME/CFS. Scottish Provident refused to clarify.

I made a DPA application to Scottish Provident who stated in their notes that I was refusing to engage in therapy and so get better. What I had actually said was that I would engage in therapies and treatment recommended by my NHS medical team.

Getting nowhere I took my case to the Financial Ombudsman Service (FOS). The FOS told me I had to provide 'compelling medical evidence of total permanent disability', but refused to disclose what they meant by this. Insurers, by dealing with the FOS over a number of years, know exactly what is required.

In an email to Scottish Provident (obtained under the DPA) I discovered that the FOS commented to Scottish Provident that it was clear I am very ill indeed, that the insurer would probably have to pay out, so why not pay out now?

After deliberating for over 2 years the FOS ruled in favour of my insurer saying that although my consultant had stated 'I can state the certainty that this patient will never work again' my insurer was entitled to explore further treatments for depression. The FOS also said that my ability to understand the issues and my persistence is evidence of my ability to work. A real no-win situation, if I had not persisted my claim would not be paid.

The FOS added that a way forward could be for me to obtain a further report from a psychiatrist commenting on my mental health.

So I obtained a report from a psychiatrist specialising in the field of ME/CFS. He confirmed the diagnosis of ME/CFS, agreed with my first consultants opinion regarding prognosis and stated I am not depressed.

I sent this report to Scottish Provident in November 2008 who continued to refuse my claim on the grounds that the psychiatrist had not included 'clinical objective evidence'. I asked Scottish Provident what they meant by this but they refused to clarify.

By this time I had become very ill indeed. I decided I could no longer cope and chose to employ a specialist solicitor. He recommended obtaining further medical evidence from yet another ME/CFS Consultant. This I did last summer.

At the beginning of this year Scottish Provident finally admitted my TPD claim dropping their insistence on further 'therapies'. It would appear that the involvement of a specialist solicitor and the weight of medical evidence finally persuaded Scottish Provident that their position was untenable.

Over the years I have spoken to a number of people claiming PHI and TPD as a result of ME/CFS. Their experience has been uniformly poor. One lady was told by Norwich Union not to bother obtaining medical evidence as they would only take into consideration evidence provided by their 'experts'. I have documentary evidence (obtained under the DPA) that Scottish Provident lied to me and misled me. My NHS medical team has told Scottish Provident that their tactics have made my illness more severe.

I see from some of the previous posts that a high percentage of CI claims are paid out. I suspect that this is the percentage of claims that are pursued. There is a proportion of legitimate claimants who simply give up because they are too poorly to cope with the tactics of their insurer and/or do not have the savings to pay for private medical reports and solicitors.
'Now sir you tell me the world's changed
Once I made you rich enough
Rich enough to forget my name'
Youngstown

Eleventh Heaven = no 166 - none yet but 50 weeks to go:cool:

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Replies

  • OshayAwayOshayAway Forumite
    715 posts
    ellie43 wrote: »
    I see from some of the previous posts that a high percentage of CI claims are paid out. I suspect that this is the percentage of claims that are pursued.
    No, the stats are from all claims registered. That includes the policyholder who rang the insurer to register a claim under the 'loss of speech' definition last year. An actual example which is included in the 'declined for not meeting the definition' figures.
  • Molly41Molly41 Forumite
    4.8K posts
    Part of the Furniture 1,000 Posts Name Dropper Photogenic
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    Thanks for sharing your experience. I am in a similar position myself. I dont have your conditions but it sounds a similar scenario. Would you mind if I PM you as I could really do with some advice on how to proceed? Many thanks
    I must not fear. Fear is the mind-killer.
    Fear is the little-death that brings total obliteration.
    I will face my fear. I will permit it to pass over and through me. When it has gone past I will turn the inner eye to see its path.
    When the fear has gone there will be nothing. Only I will remain.
  • Molly41Molly41 Forumite
    4.8K posts
    Part of the Furniture 1,000 Posts Name Dropper Photogenic
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    Is DPA data protection act?
    I must not fear. Fear is the mind-killer.
    Fear is the little-death that brings total obliteration.
    I will face my fear. I will permit it to pass over and through me. When it has gone past I will turn the inner eye to see its path.
    When the fear has gone there will be nothing. Only I will remain.
  • ellie43ellie43 Forumite
    446 posts
    Insurers are happy to publicise claims such as the one that you mention, but are not prepared to put their house in order regarding the way in which they conduct claims in cases such as mine.There is no body which regulates this and in my experience 'treating customers fairly' is a farce. I would not have taken out the CI policy (and many others probably would not either) had I known that my insurer would refuse to tell me what medical evidence it requires, and from whom, to satisfy the policy definitions.
    'Now sir you tell me the world's changed
    Once I made you rich enough
    Rich enough to forget my name'
    Youngstown

    Eleventh Heaven = no 166 - none yet but 50 weeks to go:cool:

  • ellie43ellie43 Forumite
    446 posts
    Hi Molly
    Have PM'd you!
    :)
    'Now sir you tell me the world's changed
    Once I made you rich enough
    Rich enough to forget my name'
    Youngstown

    Eleventh Heaven = no 166 - none yet but 50 weeks to go:cool:

  • Insurers are happy to publicise claims such as the one that you mention, but are not prepared to put their house in order regarding the way in which they conduct claims in cases such as mine.There is no body which regulates this and in my experience 'treating customers fairly' is a farce. I would not have taken out the CI policy (and many others probably would not either) had I known that my insurer would refuse to tell me what medical evidence it requires, and from whom, to satisfy the policy definitions.

    correct on all accounts ellie :beer:, they want your premiums though :o
    Campaigning to recycle Insurance Policies into Toilet Paper :rotfl:

    Z
  • jamesperrettjamesperrett Forumite
    943 posts
    Tenth Anniversary 500 Posts Name Dropper
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    Trudy Chalder has a great deal to answer for when she espouses CBT for ME/CFS. She seems to have convinced the NHS that it is the only treatment that works while conveniently ignoring the large proportion of people who don't respond. Unfortunately related bodies like your insurance company have also accepted her ideas.

    My wife had severe ME for around 12 years and, while possibly not fully recovered, is now sufficiently well to work part time. She happens to be in the Mental Health business and is always commenting on how inappropriate many suggested treatments are. Having said that, she has found that certain psychological therapies are beneficial at the right stage of recovery - but never as a general cure-all for ME/CFS.

    James.
  • ellie43ellie43 Forumite
    446 posts
    Yes James, I agree.

    It is interesting that the 'school' of psychiatrists who espouse CBT/GET for ME/CFS have close links with the insurance industry. The Chief Medical Officer for Scottish Provident who reviewed my claim for Scottish Provident was Prof Peter White who also heads the ME/CFS clinic at Barts. This clinic only 'treats' mild/moderate cases with - you've guessed it - CBT/GET. Even NICE doesn't recommend CBT/GET for the severely affected, yet that didn't stop PW advising my insurer that my claim should be refused until I undertook CBT/GET again.

    Also it is very easy to blame the patient if CBT/GET is not effective, rather than looking more closely at the efficacy of the therapy. As my consultant commented there is no longitudinal research evidence that CBT/GET is remotely curative, or in the case of the severely affected can bring about enough of an improvement for the patient to return to work. The main problem with the research into the efficacy of CBT/GET is the selection of patients. A very wide definition of 'chronic fatigue' has been used, rather than for instance the Canadian Criteria for ME/CFS. There is a huge difference between 'chronic fatigue' and ME/CFS.

    I am very pleased to hear your wife has improved, especially as she was severely affected. This illness can be very disabling and I wouldn't wish it on anyone.

    Ellie
    'Now sir you tell me the world's changed
    Once I made you rich enough
    Rich enough to forget my name'
    Youngstown

    Eleventh Heaven = no 166 - none yet but 50 weeks to go:cool:

  • OshayAwayOshayAway Forumite
    715 posts
    Did you get a payout in the end ellie?
  • ellie43ellie43 Forumite
    446 posts
    Yes Oshay, I did get a payout - after 5 years and after I got a specialist solicitor from London involved. It was in the insurers interest to delay as long as possible as the policy was a decreasing lump sum designed to pay off a repayment mortgage.
    'Now sir you tell me the world's changed
    Once I made you rich enough
    Rich enough to forget my name'
    Youngstown

    Eleventh Heaven = no 166 - none yet but 50 weeks to go:cool:

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