Critical illness insurance claim - wish us luck!

gadgetmind

After paying £160pcm for over seven years for joint CI insurance , we're about to find out if it was worth it.

She's been diagnosed with what we're pretty sure is the "right kind" of breast cancer (invasive rather than DCIS), we claimed within the 13 week deadline, and we can't think of anything relevant we didn't tell them. She did have a breast lump investigated many years ago, but it turned out to be a cyst. We're pretty sure we told them but it's also clearly not relevant.

She's now had two operations (second because 1st showed it was invasive and they had to go back for more and to remove some nodes) and radiotherapy.

We're expecting this to take months, and for them to kick and struggle every step of the way, but research suggests we're likely to win in the end.

However, some women have had mastectomies, even double ones, only to be told they didn't meet the CI definition of cancer. They then can't get further insurance, including travel insurance, because they'd had cancer!

ACG

The only way reason it would take months is if your surgeon or GP drag their feet.

I used to work for an insurer as an account manager (up until the beginning of the year). My job was to get more business in, so i always wanted the customer to win otherwise it could effect the relationship i had with the IFA.

If an IFA contacted me, i would hound the GP, the claims team and anyone i could to keep it moving.

I wouldnt worry about them struggling to pay. you only hear about the bad stories in the press never the good ones. Ive seen both, and usually if they dont pay out its because its either a borderline case or it didnt meet the condition or lies.

You are usually looking at about 2-3 weeks for your surgeon and GP to get everything back to the insurer. Ive known GPs to take upto6 weeks. Once the insurer has everything they need you will be looking at about 2 weeks to get a cheque.

I wouldnt worry until they actually say no - 9 out of 10 cases get paid out. Check the Critical Illness claim stats of your insurer. most pay out over 90%.

gadgetmind

Thank you for your encouraging comments.

Both surgeon and GP are generally good eggs, both of whom seem like very well organised people. For instance, the surgeon's assistant calls every couple of weeks just to check everything is OK, and my wife's GP is the same lady she's been going to for over a quarter of a century.

Regards worrying, this money has never been in our financial plan, so we won't miss it should they interpret a word in subsection 9d of clause 71 in some unusual way and ever so politely decline to pay. I must admit that my spider senses tingled when I read "meets their definition of cancer" with exactly that use of bold.

My wife felt the need to point out that if (big if!) they pay out, she will have earned more than me this year. I observed that she'll also have done it using just her left breast, and speculated on how much more could we could have got if she'd used her whole body. :-)

[edit]

While there was a box to keep our IFA informed, we chose not to tick it as we saw little value he could possible add. Was this a mistake?

Annisele

If the policy was sold to you by an IFA, then I think it would certainly be worth going back to him and letting him know that you're making a claim.

Worst case: he couldn't care less.
Best case: he's extremely helpful about chasing people up on your behalf.

My (admittedly limited) experience leads me to suspect the latter.

pedro123456

Gadget, you and your lady do right to be a little pessimistic about your claim, my thoughts are you are about to witness the IC trying to squirm out of settlement, but lets hope you have a good result and that the IC "play the game"

I wish your lady all the best of health. Good luck

ACG

Aviva (who i personally cant stand as theyre slow as anything) Paid out 93% of all Critical Illness claims - jan-june 2010
L&G Paid 93.6% in critical illness claims - 2009
Liverpool Vic - 87% in 2008.

Whilst some of these are old news - it just goes to show how big a percentage they are paying out. As i said you only hear about the negative stories. Ive got to see both sides.

As for keeping your IFA informed - it wont increase or decrease your chances of any pay out. However he probably earnt a fair chunk on the back of this policy. So he could be making your life easier - but its entirely upto you if you want to involve him or not.

My personal opinion is that, any customers i have, im there for the good times and the bad. He may also have had claims go through before so can keep you advised step by step - even if he hasnt, he may learn from the experience and it may help in the future.

gadgetmind

ACG wrote: »

Whilst some of these are old news - it just goes to show how big a percentage they are paying out. As i said you only hear about the negative stories. Ive got to see both sides.

As part and parcel of having breast cancer, my wife hung around on some of the forums. OK, I accept that you hear more about the negatives, but boy are the negatives negative! Some insurance company mess people around something rotten, and cause massive worry and stress to women who are undergoing physically and emotionally damaging surgery, chemotherapy, and radiotherapy, and all the while with the threat of the cancer spreading to their bones and organs hanging over their heads.

Showing what percentage of claims are eventually paid is perhaps masking the fact that people are still having to fight long and hard, and even go to the ombudsman, to get their claims settled.

We're lucky: we don't need the money, and we like a good scrap every so often.

ACG

I agree with what your saying, some people do have to fight tooth and nail over a technicality (ie one company wouldnt pay out to someone in a coma, because they couldnt have tests to confirm brain damage...or something along those lines).

But even if you said half of those claiments had to go to the ombudsman (which they dont), you still looking at every other claim being paid out. Most (not all) of the stories you will hear about are people trying to make a claim on the "catch all" condition TPD (total and permanent disability), rather than an actual named condition (cancer, heart attach etc) as its more specific.

You havnt said who your cover is with... is that for a reason?
http://www.friendslife.co.uk/doclib/cxsad138.pdf - 2009 Friends Life/Friends Provident paid out just shy of 93% of all claims of which 68% were for cancer.

If it never paid out, people wouldnt take out the policies in the first place. Theyre not out to con people.

Im going to stop trying to boost your optimism now. Let us know how it goes though, and how you found the experience with the company your dealing with. It will help myself and others in the future.

gadgetmind

ACG wrote: »

Most (not all) of the stories you will hear about are people trying to make a claim on the "catch all" condition TPD (total and permanent disability), rather than an actual named condition (cancer, heart attach etc) as its more specific.

Most stories we have seen are from women with serious breast cancer, that requires extensive and disfiguring surgical treatment (aka breasts removed), but for which CI claims are laughed off. Even if we win, it doesn't excuse the wrongs the insurance companies have done, no matter now much the minutae of the law may justify their (in)actions.

You havnt said who your cover is with... is that for a reason?

It's Scottish Provident, and no, there was no reason for not saying who it was; insurance companies are as insurance companies do, and the really are much of a muchness,

pedro123456

CIC is sold as a must have, cant do without product, its clever marketing by the IC for the IC, they spout claims of 93% payout, which again is clever (but manipulative) statistics.

Its sold as "have a stroke/heart attack/CA etc and your covered " people are not made aware of the how the IC's definition are full of get out clauses, by the very nature of them being definitions made by the IC for the IC of course.

When a claim is made it's the old "yes but no but", just because your consultant diagnosed it, that doesn't mean you have had one of OUR strokes/heart attack/CA.

You have to meet the IC's definition to the letter, or kiss your claim goodbye.

They pay out 93% of how many claims?, the IC don't declare the CLAIM RATE figures why not?

It would be interesting to know if these 93% pay outs include claims upheld by the FOS. Maybe OshayAway and his crew could shed some light on the issue.

gadget fingers crossed for you and your wife

weighty1_2

pedro123456 wrote: »

CIC is sold as a must have, cant do without product, its clever marketing by the IC for the IC, they spout claims of 93% payout, which again is clever (but manipulative) statistics.

Its sold as "have a stroke/heart attack/CA etc and your covered " people are not made aware of the how the IC's definition are full of get out clauses, by the very nature of them being definitions made by the IC for the IC of course.

When a claim is made it's the old "yes but no but", just because your consultant diagnosed it, that doesn't mean you have had one of OUR strokes/heart attack/CA.

You have to meet the IC's definition to the letter, or kiss your claim goodbye.

They pay out 93% of how many claims?, the IC don't declare the CLAIM RATE figures why not?

It would be interesting to know if these 93% pay outs include claims upheld by the FOS. Maybe OshayAway and his crew could shed some light on the issue.

gadget fingers crossed for you and your wife

L&G alone paid out approximately £150MILLION in critical illness claims last year. Doesn't sound like an industry squirming to get out of paying to me!!

The definitions for the 20-odd most common conditions are standardised across the industry, so cancer with Scottish Provident is the same as cancer with Friends Life. The exception to this is when a company improves on the definition making it easier to claim, not harder. These definitions are not designed as "get out clauses" but more to ensure that each and every customer, and the IC, are treated in the same manner as to whether a claim is upheld or not.

I presume Pedro that you don't have life/critical illness/income protection cover, as your scepticism seems to know no bounds. For your sake, I hope in future you never think, "If only I'd taken out......."