Dump the critical illness?

OshayAway

pedro123456 wrote: »

Grow up oshayaway and stop your bullying

Sorry Pedro, just a little light-hearted banter.

In fact, I hope you are sitting down because I actually agree with you on this point. The questions asked on a GP report (for the purposes of underwriting the policy) are very specific as the answers should be. When surgeries send a copy of all medical records this can prejudice the underwriting outcome.

ellie43

The problem is Shelly that when given full access to medical records, as in my case, the insurers wilfully ignore supportive medical evidence and misinterpret other information.

As I said above my insurer on reviewing my medical records manufactured 2 conditions which they said also required treatment:
1. Depression - despite the fact that I had in the previous 6 months provided them with a consultant psychiatrists report stating that I did not suffer from mental illness of any kind
2. Obesity - for which there is no evidence whatsoever. (I weigh less than 8 stone and always have)

Surely on the claim form the claimant will say under which condition they are making the claim and it is medical evidence relating to this condition which is relevant. If this is supported by the claimants GP and consultant and complies with the ABI/BMA guidelines, then that should be enough.

I very much dislike the fishing around in medical records. My insurers so called medical expert who 'assessed' me dredged up a traumatic event in my childhood which had no relevance to my claim at all.

shelly42 wrote: »

Perhaps you'd be so kind as to confirm exactly what information contained in a claimant's medical history would not be considered relevant when assessing a life or critical illness claim?

shelly42

pedro123456 wrote: »

Certainly Shelly.

Whatever the Medical professional deemed "relevant" as per joint BMA/ABI guidelines of course.

What im trying to say is that when underwriting a plan, or assessing a claim, the client's full medical history is relevant anyway. There would be very little information in a client's history which would not be relevant.

And you do realise that the document you are referring to are guidelines only, not legally binding. The same document also says that GPs should return medical evidence within 20 working days. I can assure you that this does not always happen.

pedro123456

Here you are OshayAway from me to you with love :kisses3:

Nick Kirwan, the ABI’s Assistant Director, Health and Protection, said:

“We have explored a number of ways to help make claiming TPD easier for customers, which did include changing the name of the benefit. However, customer research did not strongly support this idea. After careful consideration we have now agreed standard definitions, training packs for advisers, an online hub of information and much clearer steps for customers which we believe will make the process easier and increase successful valid claims.

“Throughout we have taken a very inclusive approach to addressing this complex issue and we have had feedback from advisers, consumers, and a wide range of other stakeholders including regulators and the Financial Ombudsman Service.”

- The new Statement will be issued in early 2011.
- The heading Total Permanent Disability will remain but will be extended to make the scope of the cover much clearer. This means that the education programme can apply to both new and existing policies to make the most difference in helping to reduce the proportion of declined claims.
- ABI members will be required to implement the policy when making updates to their CI policies.

Kirwan says it so much clearer than you mate.

He's a pro at bull sh1te :rotfl:

pedro123456

Yes guidelines shelly.

Definition

Recommended practice that allows some discretion or leeway in its interpretation, implementation, or use.

And the GP and/or Consultant, should be able to decide what discretion or leeway to apply dont you think?

shelly42

ellie43 wrote: »

Surely on the claim form the claimant will say under which condition they are making the claim and it is medical evidence relating to this condition which is relevant. If this is supported by the claimants GP and consultant and complies with the ABI/BMA guidelines, then that should be enough.

I very much dislike the fishing around in medical records. My insurers so called medical expert who 'assessed' me dredged up a traumatic event in my childhood which had no relevance to my claim at all.

Whilst I can appreciate your points, the main reason for "fishing around" in medical records is to ensure that the client has not non disclosed any information which, if it had been disclosed at the outset, would have merited the underwriter not offering the client any terms at all.

Say for example if a client is claiming under the cancer definition of a critical illness plan and had not disclosed any medical conditions on the application form. If the insurance company obtains medical records at the time of the claim which indicated that prior to taking out the policy the client had suffered 4 heart attacks and had been a heroin addict do you not think they would be within their rights to turn down the claim and refund all the premiums paid? Or do you think that as the heart attacks and drug use had nothing to do with cancer they should still pay out?

ellie43

This info can easily be obtained by the insurer asking the claimants GP and consultant(s) the relevant questions. After all they are the most familiar with the claimants medical history. In my experience both my GP and Consultant were sent very detailed questionnaires by the IC. The IC ignored the responses because they supported my claim.

My IC did not review my medical records in a fair or responsible way, as I have said above they manufactured non-existent conditions - if this is how insurers behave when they are permitted full access to medical records I see no reason why such access should continue.

shelly42 wrote: »

Whilst I can appreciate your points, the main reason for "fishing around" in medical records is to ensure that the client has not non disclosed any information which, if it had been disclosed at the outset, would have merited the underwriter not offering the client any terms at all.

Say for example if a client is claiming under the cancer definition of a critical illness plan and had not disclosed any medical conditions on the application form. If the insurance company obtains medical records at the time of the claim which indicated that prior to taking out the policy the client had suffered 4 heart attacks and had been a heroin addict do you not think they would be within their rights to turn down the claim and refund all the premiums paid? Or do you think that as the heart attacks and drug use had nothing to do with cancer they should still pay out?

shelly42

ellie43 wrote: »

This info can easily be obtained by the insurer asking the claimants GP and consultant(s) the relevant questions. After all they are the most familiar with the claimants medical history. In my experience both my GP and Consultant were sent very detailed questionnaires by the IC. The IC ignored the responses because they supported my claim.

My IC did not review my medical records in a fair or responsible way, as I have said above they manufactured non-existent conditions - if this is how insurers behave when they are permitted full access to medical records I see no reason why such access should continue.

All we have to go on this is what you're telling us. Nobody is giving the insurance companies perspective on the situation and your allegations of manufacturing conditions.

ellie43

Well shelly it is up to those reading the forum to decide for themselves the veracity of what I am saying.

The point I was making is that the info that IC's need can be obtained from the claimants GP and/or Consultant if the appropriate questions are asked.

shelly42 wrote: »

All we have to go on this is what you're telling us. Nobody is giving the insurance companies perspective on the situation and your allegations of manufacturing conditions.

AlisonHarrison

When I took out the policy I was quite happy for them to look at my medical records. I am not sure whether or not they did.
They did look at my records when I made the claim, and again was happy to sign a form to allow them access.
I also allowed them access to "other financial information" as they thought fit.
As time went on, and I made the claim, I realised the lengths they would go to in order to wriggle out of paying, so I withdrew my consent. I said that whilst I understood their need to validate certain information, they had gone too far.
If ICs behaved responsibly and reasonably then I would agree that there is no reason for them to be denied any information, medical or otherwise. Sadly this is not the case.
They so frequently misinterpret the information and ignore supportive evidence.
Perhaps this was the need for the guidance in Pedro's helpful link.

OshayAway wrote: »

Oh dear, Let me clarify. TPD is being looked at and changes implemented in the near future. However, the term TPD that is "Total and Permanent Disability" is not changing. Along with the changes to the cover itself, there was a proposal to change the name to "irreversible Life-Changing Disability" but this was abandoned at the end of last year following poor customer feedback.

You said in post 23 you thought the ABI had decided in December not to change the TPD definitions and then asked if you were wrong. I'm sorry if you only wanted an answer from Dunstonh on this public forum but what I stated is not contradictory but factually correct.

Is that a little clearer?

(I'm tempted to make a comment about not reading the (not so) small print but will resist... oops))

Nice attempt at wriggling out of previous comments but not quite good enough.
See Pedro's response for some helpful comments. But I am sure like always, you will want the last word, so I will let you have it.