Refusal of Payout of Sickness Insurance for cancer sufferer

PAK

Hi,

I'm not sure where we stand, so was wondering if anyone can recommend some help here.

My wife was made redundant last year in March 2009. She was ill from April 2009 and was diagnosed with the cancer in June 2009. She was eventually okay in August, though only for a few weeks before she was diagnosed with Cancer elsewhere. By the time she had an op and treatment, she wasn't okay until up to now (July 2010).

We are both covered for sickness insurance with Scottish Provident up to three months. They are refusing to payout because she was made redundant. My argument is that she was hardly able to get another job because she was too ill (she was on ESA). If we are unable to get a payout, then what have we been paying for, for the last year, if they are refusing to pay?

How can they refuse to pay when all the doctors and medical professionals say that she was too ill to get another job?

Thanks and sorry if I'm ranting as I'm fuming with them. :mad:

Paul

OshayAway

What's the exact name of the plan as shown on your policy document?

dunstonh

It is important we know what the plan is.
Was it a personal insurance or one arranged by the employer?

One of the most common reasons for refusal with income/illness plans is that you are not covered for what you are claiming for. So, it could be that the policy cant pay out as the event is not something they insure.

PAK

The Plan is a Self Assurance Personal Term.

They refused to payout because they said that she could walk 200m, pick up a 1kg item and walk 5m, speak clearly, hear fine and use a keyboard/mouse.

The fact is that she was signed off sick because of cancer and the chemotherapy seems to be irrelevant. If she injured her leg and was unable to walk, they'd pay out. She was signed off sick mainly because she was suffering from fatigue caused by the chemotherapy and due to the huge scar causing her discomfort and the time it takes to heal.

Thanks for the replies guys.

dunstonh

The Plan is a Self Assurance Personal Term.

What options were held under that product? Life assurance, critical illness cover (CI), payment protection insurance (PPI), permanent health insurance (PHI)?

I am just guessing here as there isnt enough to go on yet. However, it looks like your wife didnt have critical illness cover (which covers cancer) but permanant health insurance (task based). As there is no CI cover in place, they wont pay out. As its a budget income protection based on the ability to do tasks, if she can do the tasks she doesnt get a payout. The type of illness itself on task based income protection is not really that relevent. Its the impact of the illness on the ability to work either own occupation or any occupation or selected tasks (depending on the type of cover you buy)

This is one of the reasons why getting both PHI and CI is important as there are areas you leave yourself uncovered if you dont.

PAK

According to the Plan, she is on a Premium Payment Benefit, which covers sickness, disability and accident. There is no mention of CI as an option of this plan.

dunstonh

PAK wrote: »

According to the Plan, she is on a Premium Payment Benefit, which covers sickness, disability and accident. There is no mention of CI as an option of this plan.

Thats why then. The plan has a range of options that can be chosen to be held within it. Hence why we needed a bit more detail as it could be just pure life assurance, critical illness cover or payment protection or a combination of these.

The plan is a payment protection style income protection only and doesnt have the critical illness cover option (which is what would have paid out in this case). So, in that case, a rejection by the insurer seems correct I'm afraid.

hwalkerh

It is hard to say with out knowing the exact conditions of you policy. Is this related to your mortgage or do you have a set amount a month that you set it to pay out?

From what you have said about it being a premium payment benefit i found these details on there website

"Premium payment benefit (sickness, accident or disability) will protect your premiums if, because of sickness, accident or disability, you cannot work or perform 2 out of 6 work tasks or 3 out of 6 life tasks. You will start to receive this benefit after the deferred period you choose, which can be 13, 26 or 52 weeks (4 week deferred period also available if chosen with disability income benefit)."

On this basis you aren't asking for it to pay out critical illness payment which would be a lump sum. The insurance won't pay for 3 months but is probably deferred for 3 months so you have to wait 3 months then it starts paying out.
For sickness which would be a monthly amount i believe it seems to state they will pay if you cannot work or perform 2 out of 6 work tasks or 3 out of 6 life tasks.

Most insurance companies work on the benefit that someone is claiming so if claiming incapacity benefit then it would be a sickness claim and if claiming job seekers allowance then it would be a unemployment claim. If claiming incapacity then that could be used to argue that she couldn't work.

I would pursue itand check that they are looking at the right sort of claim for you. If they don't pay out and you have sickness cover i would complain to the company first then if no luck go to the financial ombudsman.

You need to check your policy carefully and check exactly what you cover is

beverly_hills

dunstonh wrote: »

Thats why then. The plan has a range of options that can be chosen to be held within it. Hence why we needed a bit more detail as it could be just pure life assurance, critical illness cover or payment protection or a combination of these.

The plan is a payment protection style income protection only and doesnt have the critical illness cover option (which is what would have paid out in this case). So, in that case, a rejection by the insurer seems correct I'm afraid.

Hi, reading with great interest as I'v had unbelievable nightmares with insurance companies which has taught me lots. You seem well informed on this topic, so can you put me clear on the definition of "critical Illness"? As I understand it, if this lady had had CI in place, the cancer would have defiately covered the claim, but if the cancer is not terminal, and they expect her to recover & go back to work, surely this would be covered in the sickness section? I would advise that this is definately worth checking.
My own experience is an ongoing claim, after being diagnosed with depression, IP underwriters tried to use the exclusion of "stress related illness" to deny my claim. After many months of fighting with them and informally contacting FOS, they had to accept that my condition fell under the "mental incapacity diagnosed by a consultant". They'll always try to find any way to not pay out, so don't give up or be beaten down by them, play them at their own game.

OshayAway

beverly_hills wrote: »

My own experience is an ongoing claim, after being diagnosed with depression, IP underwriters tried to use the exclusion of "stress related illness" to deny my claim. After many months of fighting with them and informally contacting FOS, they had to accept that my condition fell under the "mental incapacity diagnosed by a consultant". They'll always try to find any way to not pay out, so don't give up or be beaten down by them, play them at their own game.

Is it a PHI cover or AS / (M)PPI policy?

beverly_hills

Hi, it's an income protection policy.