Help Insurance co. Might not pay out!

KITTEN8

Help, am panicking. Someone I know was an alcoholic. Insurance co. Were aware of this. She died of alcohol poisoning. They have had her medical records for 7 days now. They phoned me to ask questions about her drinking. I told them the truth and they said they get back to me next week,
I am panicking that this delay and questioning a family member is a bad sign and they are going to refuse to pay out. Have I made the situation worse? Is soooooo stressful having to wait the weekend to find out. What do you think? What could they possibly learn from me that is not in her medical records? If they don't payout the person they left behind is going to be in huge financial trouble!

McKneff

Stop worrying, it really is not your fault or problem.

You told the truth, its as simple as that.

They will learn far more from the GPs records than you told them.
And if they dont pay out, its the person who died who carries the responsibility (or did, sorry) It will have been in the terms and conditions of the polic whether they pay out on reasons for certain deaths.

Lets look at it another way, if you had lied and said she didnt drink much at all, then they saw from GPs records
that she was an alcoholic, then you would have felt guilty about lying, now wouldnt you.

onlyroz

You did the right thing by telling the truth. What will happen will happen - and if the payout doesn't occur then maybe the rest of the family can rally round to help out those left behind.

KITTEN8

Thanks, but easier said then done. I told the truth because I am asumming they know everything anyway, rather then it being the right thing to do. Will let you know the outcome! Anymore thoughts welcome:)

McKneff

You assume right, they will know everything anyway, without your input.

Hope everything goes well.

KITTEN8

Ok. Back again over a year later. But because of a mistake on their side. I am still within my time limit to dispute this.

After going through all the persons paper wk. The only thing I could find is the policy stating "because of your health you have to pay an extra premium each month on top of your normal rate." Now that's why I thought they knew about the drinking.
But they say they didn't know about any drink problem and this extra premium is for another health reason.

But my argument is the desceased also thought this meant the very obvious health reason of her drinking and she actually told me when she was alive about this letter from the insurance co. she got. She happened to have a doctor appointment to discuss drink problem then signed the insurance to say they have access to her medical records and then this letter arrives. So this person now thinks they know the history and is covered. But why didn't they state the health reason on the paper wk!

So basically there was never any paper wk to tell the person exactly what this extra premium health reason was! This is unfair, misleading and confusing for the policy holder.

I would love to hear any advice or opinions on this and do you think the ombudsman would think the same as I do.?

Thanks x

whitewing

What date did she sign to give access to her medical records?

What date was the letter that she received after her doctor's appointment?

Based on what you've said so far my opinion is that she may have been misled.

If you are an alcoholic with insurance then what conditions would be paid out? Surely most things could be attributed to the alcoholism?

anguk

whitewing wrote: »

What date did she sign to give access to her medical records?

What date was the letter that she received after her doctor's appointment?

Based on what you've said so far my opinion is that she may have been misled.

If you are an alcoholic with insurance then what conditions would be paid out? Surely most things could be attributed to the alcoholism?

In my opinion insurance companies will use anything they can to get out of paying. We gave up trying to get my diabetic husband insured because they basically said if he died of any condition that could be attributed to diabetes it wouldn't be covered. As diabetes can be linked to almost anything it just wasn't worth getting the insurance.

My guess is there'll be a clause in the insurance document that says if she dies of anything that can be linked to a pre-existing condition (alcoholism) then they won't pay out.

CRANKY40

I pay extra on my insurance as I'm asthmatic. When I took the policy out I had a letter saying that I had to go for a medical first. After I had the medical they then wrote to me telling me how much the insurance was and how much I would be paying extra because of the asthma.

If your relative put alcoholic on the application forms, then maybe you stand a chance. If they were just guessing that the insurance company knew....then it's looking a bit iffy I would think.

fluffnutter

I worked for some time in life assurance. If her alcoholism was known the insurance company can do one of four things:

1. refuse to insure her
2. increase her premium
3. include a specific exclusion which will say something along the lines of 'if you die of an alcohol related cause, we will not pay out'
4. insure her normally

Unless there's evidence of (3) in her policy the insurance company is not entitled to refuse to pay out. Even if (2) has happened, the fact that she paid the increased premium means that she would have been covered regardless of how she died.

I also think it's rather dodgy of an insurance company to phone up a friend and start asking questions - you're under no compunction to tell them anything (it's nothing to do with you) and I can't help but think this is an underhand way to get information. Are you the beneficiary of the policy? Not that it makes much difference; you just seem to have more involvement than a friend would usually have.

All that aside, if the insurance company fails to pay out, and you can't find evidence of a specific exclusion relating to alcoholism (and you're sure she told them), then follow their complaints procedure first and if you have no joy, try the press or the financial ombudsman.

If she didn't disclose her alcoholism, the insurance company is entitled to deem the entire policy void and refuse to pay out. Good luck.

Edwardia

I have diabetes. I'm covered for free under OH's insurance with his bank and they are quite happy to insure me with diabetes so shop around.