L&G ASU - my complaint not upheld

JamesMcD

Background: In 2006 My partner took out a mortgage for our 1st home. We went to The Mortgage Shop. The FA there told us that it would be wise to take out ASU (now known as PPI). She also said it would be beneficial and wise to take out Life Assurance with Critical Illness Cover. We were a bit naive and green about the whole mortgage thing as it was our first time dealing with this kind of thing. We just trusted I guess. She asked us where we worked and we told her. We both work in Public Sector and have done for 10 years.

Fast forward to about a month ago and I was in the process of changing bank accounts. I had a lot of direct debits to change over and happened to have some paperwork on my desk in work relating to these 2 policies. They are with L&G. We have been paying £17.74 for the ASU and £69.03 for Life Assurance with CIC since 2006. My boss asked why i had these as my job covers me and there was no need for ASU. We get paid for 6 months full pay and 6 months half pay. I was a bit shocked that I could have been paying this money for the last 5 years and didn't really need to!

I wrote to L&G regarding the ASU and they wrote back saying that the policy was not mis sold. I told her that the FA knew we both worked in Public Sector. If one of us does go sick can we claim on this ASU as well as receive full pay whilst sick? I don't really understand if we were mis sold or not and don't really know what to do now. Can someone advise?

dunstonh

Another person using a tied sales rep from L&G and not happy with their advice. This is turning into a very frequent occurrence despite them only being a fairly small salesforce.

I wrote to L&G regarding the ASU and they wrote back saying that the policy was not mis sold. I told her that the FA knew we both worked in Public Sector. If one of us does go sick can we claim on this ASU as well as receive full pay whilst sick? I don't really understand if we were mis sold or not and don't really know what to do now. Can someone advise?

Sickness cover and payment protection as different things. Some payment protection plans will not pay out if there is sickness pay being made. Some will. So, you need to ask L&G if they would pay out if you were in receipt of sick pay. If they would then you cant use that as a complaint reason. If they wouldnt pay out then it is a valid complaint reason.

roonaldo

JamesMcD wrote: »

She also said it would be beneficial and wise to take out Life Assurance with Critical Illness Cover.

Yes, it is good advice. The critical illness is worth having as would pay off your mortgage. Also the life would pay off the mortgage if one of you died.

We were a bit naive and green about the whole mortgage thing as it was our first time dealing with this kind of thing.

Then its a good job you took PPI, as this will provide valuable cover for your most imporant asset.

We both work in Public Sector and have done for 10 years.

Good job you have it with all the cuts local authorities are making.

My boss asked why i had these as my job covers me and there was no need for ASU. We get paid for 6 months full pay and 6 months half pay.

Is he qualifed to give you advice or even know what he's talking about? The PPI would still pay out on top of work sick pay. Was this dislcosed to the adviser when you took it out? I doubt your job would have provided you with unemployment cover too.

I was a bit shocked that I could have been paying this money for the last 5 years and didn't really need to!

Thats easy to say now, but insurance is to cover what could happen.


Dont confuse a monthly PPI policy with the bad press single premium PPI on unsecured loans. They are slightly different products and sold completely different. The adviser would have done a fact find and would have provided you with a demands and needs statement. Even FOS reject a majority of mortgage PPI complaints.

marshallka

roonaldo wrote: »

Is he qualifed to give you advice or even know what he's talking about? The PPI would still pay out on top of work sick pay. Was this dislcosed to the adviser when you took it out? I doubt your job would have provided you with unemployment cover too.




.

Roonaldo, how do you KNOW that the MPPi would pay out on top of sick pay..... here is an extract from an insurer that DOES make it clear when selling their product..

i:protect Mortgage Payment Protection Insurance is designed to kick in when your sick pay or redundancy pay in lieu of notice comes to an end.

NOT all pay out and its better to check your terms and conditions. On ours it makes no mention whatsoever about sick pay.


Another here
Some Public Sector workers, such as Nurses, have an employment package that will pay (in the event of accident or sickness) 6 months full salary followed by a period of half salary. Please note that you cannot claim benefit unless you are in receipt of Statutory Sick Pay so you would not be able to claim whilst in receipt of full pay.

roonaldo

marshallka wrote: »

Roonaldo, how do you KNOW that the MPPi would pay out on top of sick pay..... here is an extract from an insurer that DOES make it clear when selling their product.

Legal and General dont use Iprotect insurance. I spend most my days at work looking at the terms and conditions, and most do cover on top.

It also sounds like a no-frills type policy, a lot of the older policies and polices and insurers like Cardif Pinnacle provide a more comprehensive cover.

i:protect Mortgage Payment Protection Insurance is designed to kick in when your sick pay or redundancy pay in lieu of notice comes to an end.

Some Public Sector workers, such as Nurses, have an employment package that will pay (in the event of accident or sickness) 6 months full salary followed by a period of half salary. Please note that you cannot claim benefit unless you are in receipt of Statutory Sick Pay so you would not be able to claim whilst in receipt of full pay.

Doesnt sound like a good policy. A majority of policies would pay out after being off work sick for at least 30 days with employer sick pay often not taken into account.

dunstonh

iprotect is a budget product aimed at the budget market. Its for people that want to pay premiums to make them feel better than doing nothing and not for people that pay premiums to give them the cover they need.

marshallka

dunstonh wrote: »

iprotect is a budget product aimed at the budget market. Its for people that want to pay premiums to make them feel better than doing nothing and not for people that pay premiums to give them the cover they need.

I was not promoting them Dunstonh. I was highlighting FACT that not all MPPI's pay out (in fact from googling this afternoon I have not found one that actually states they do although some avoid the question and only refer to paying out alongside statutory sick pay!!!) alongside FULL company sick pay. Roonaldo said in a general posting that MPPI/PPI would pay out with sick pay and the OP had noted it was full sick pay for 6mths and half pay for another 6 months.

I was actually saying at least their terms and conditions make things clear unlike some.

marshallka

roonaldo wrote: »

Legal and General dont use Iprotect insurance. I spend most my days at work looking at the terms and conditions, and most do cover on top.

It also sounds like a no-frills type policy, a lot of the older policies and polices and insurers like Cardif Pinnacle provide a more comprehensive cover.

Doesnt sound like a good policy. A majority of policies would pay out after being off work sick for at least 30 days with employer sick pay often not taken into account.

On top of full sick pay?

You state about Cardif Pinnacle being a more comprehensive cover??? How can you say that. Terms and condition stating everything would be nice. Even now when I look at Cardif site for MPPI it does not make any mention in their terms and conditions of claiming whilst receiving full sick pay. It only says on their site when you look at the question that they

Paid direct to you in addition to any other benefits (i.e. Statutory Sick Pay)

They do not define "other benefits" and they do not say about Employers sick pay. Are we to guess and assume? They may sell on a non advised basis but if you call they will say they do.... cause they will but then when you come to claim there is a good chance they will not as you are still in receipt of an income. They will then say "refer to your terms and conditions and key facts docs" which make no mention of this. It would then be at their discretion I would say and insurance should not be risk should it and a lets guess thing.

They also state this about their terms and conditions

6. Variations

We reserve the right at any time without notice to revise the content of our website (including the services offered by us) and these Terms and Conditions. Any changes to these Terms and Conditions will be posted on our website and by continuing to use our website following any such change you will signify that you agree to be bound by the revised Terms and Conditions.


I thought they would at least have to send you their variations every now and again or reminders every now and again?



At least the other insurers I have shown have decent terms and conditions that allow a consumer to make an informed decision, that is the point I was making.

I have heard you mention Cardif Pinnacle quite a few times now Roonaldo. Do you work for them now by any chance lol...

magpiecottage

marshallka wrote: »

On top of full sick pay?

You state about Cardif Pinnacle being a more comprehensive cover??? How can you say that. Terms and condition stating everything would be nice. Even now when I look at Cardif site for MPPI it does not make any mention in their terms and conditions of claiming whilst receiving full sick pay. It only says on their site when you look at the question that they

Paid direct to you in addition to any other benefits (i.e. Statutory Sick Pay)

If that is what it says, then that is what it does.

They do not define "other benefits" and they do not say about Employers sick pay. Are we to guess and assume?

If they don't define them then they cannot exclude them.

when you come to claim there is a good chance they will not as you are still in receipt of an income. They will then say "refer to your terms and conditions and key facts docs" which make no mention of this.

It would then be at their discretion I would say and insurance should not be risk should it and a lets guess thing.

That is a guess and an assumption. If it is not in the terms and conditions or the Key Facts they would stand no chance of defending a complaint that they were in breach of FSA Principle 7.

They also state this about their terms and conditions

6. Variations

We reserve the right at any time without notice to revise the content of our website (including the services offered by us) and these Terms and Conditions. Any changes to these Terms and Conditions will be posted on our website and by continuing to use our website following any such change you will signify that you agree to be bound by the revised Terms and Conditions.


I thought they would at least have to send you their variations every now and again or reminders every now and again? [/quote]

You misunderstand - this is the terms and conditions for use of the website. Any contract of insurance will have its own terms and conditions. They can be revised when they are renewed (usually annually for PPI) but any changes must be communicated specifically to the policyholder.

marshallka

magpiecottage wrote: »

They also state this about their terms and conditions

6. Variations

We reserve the right at any time without notice to revise the content of our website (including the services offered by us) and these Terms and Conditions. Any changes to these Terms and Conditions will be posted on our website and by continuing to use our website following any such change you will signify that you agree to be bound by the revised Terms and Conditions.


I thought they would at least have to send you their variations every now and again or reminders every now and again?

Oh, I see, I though with it saying "services offered by us" it meant their policies. I have not heard from Pinnacle at all and they keep mentioning things about their insurance from their NOW website (since changing names from Helpupay to Helpucover) but our policy is not the same as it was taken out so long ago. It also states that the claim can only be paid in the way described in their terms and condtions but it does not describe how it is paid? We had no idea of carers cover (which they state was something we were insured for with our MPPI) but our original terms and conditions make no mention of this? Its confusing as to what terms and conditions we look at? Is it our from taking this out or the new ones on site? Pinnacle use comments from the new ones for consumers taking out policies now?

You misunderstand - this is the terms and conditions for use of the website. Any contract of insurance will have its own terms and conditions. They can be revised when they are renewed (usually annually for PPI) but any changes must be communicated specifically to the policyholder.[/QUOTE]

roonaldo

marshallka wrote: »

On top of full sick pay?

You state about Cardif Pinnacle being a more comprehensive cover??? How can you say that. Terms and condition stating everything would be nice.

here we go, this is copied and pasted from 2006 cardif pinnacle PPI policy terms and conditions, its for an unsecured loan but its exactly the same as the mortgage one. This is typical of a policy which would pay out regardless of sick pay as most do. I have quoted a cardif pinnacle as they are one of the biggest and most common insurers of PPI.

FYI, I have included definitition.

Please note that this is from a 2006 sale, anything you copy and paste from their website is going to be revised and up to date.


“disability”

means an accident, sickness, disease or injury that wholly prevents you from engaging in your occupation

or any occupation and from performing any work for payment or profit which by reason of

your experience, education

or training

you are reasonably qualified to do (in the case of the self-employed this means assisting, managing and/or
the carrying on of any part of the running of a business whatsoever);

Disability cover
(i) If after the

cover start date (or end of the deferred period, if applicable to your agreement), you become

continuously

disabled for 30 consecutive days or more, you will be entitled to an amount equal to the monthly

benefit

for the first 30 days of your disability. Thereafter, you will be entitled to an amount equal to 1/30th of the

monthly benefit

for each continuous day of disability. The monthly benefit will be paid monthly in arrears to you

provided

you meet the terms and conditions of this policy.

(ii) To receive the

monthly benefit you must:

(a) be under

regular care and attendance;

(b) not be receiving the

monthly benefit for unemployment or hospitalisation for the same period; and

(c) give

us any evidence we reasonably ask for in order to prove your claim is valid and continues to be so.

(iii) When paying

your claim we will consider the first day of disability to be the day a doctor certifies that you are

disabled

.

(iv)

Wewill continue to pay the monthly benefit until:

(a)

we have paid 60 monthly benefit payments;

(b)

you fail to provide evidence of your disability; or

(c) the

end date;

whichever happens first.

(v) The maximum monthly benefit payable under this policy is £2,000.

We

will not pay any monthly benefit if your disability results from or is a consequence of the following:

(i) a

condition:

(a) which

you knew about (or ought reasonably to have known about) at the application date; or

(b) for which

you sought or received advice, treatment or counselling from any doctor during the 12 months

immediately before the

application date;

(This exclusion will be waived if

you have been continuously insured, symptom free and have not consulted a doctor or

received treatment for the

condition in the 24 months immediately prior to your claim. However, the only exception to

this will be if

you have made appointments to see a doctor within this period and have failed to attend and have not

formally been discharged.)
(ii) self-inflicted injury;
(iii) being under the influence of, or being affected by, alcohol or drugs unless prescribed by a

doctor (other than

prescribed for the treatment of drug addiction);
(iv) civil commotion, terrorism, riot or insurrection, war or any act incidental to war (whether declared or not) or whilst
you

are on naval, military or air force duty, service or any type of operations, radiation or contamination or the

effects of radiation;
(v) any condition directly or indirectly related to Acquired Immunodeficiency Syndrome (AIDS) or Human
Immunodeficiency Virus (HIV) as recognised by the World Health Organisation unless contracted during medical
treatment which is not a result of drug abuse or a sexually transmitted disease;
(vi)

normal pregnancy, miscarriage or abortion unless the symptoms of a normal pregnancy develop into a

pathological condition, sickness or disease which is:
(a) diagnosed by a

doctor or consultant who is listed by the General Medical Council as specialising in obstetrics;

and
(b) which is not excluded under any other exclusions listed in this Clause;
(vii) any condition of a mental or nervous origin including stress, anxiety, depression and post-natal depression (unless
the condition is certified by and under the continuing care of an

appropriate specialist);

(viii) backache or related conditions unless there is supporting medical evidence. Such evidence may be a report from
an

appropriate specialist or from your doctor, in either case an MRI, CT scan, X-ray or equivalent, may be

required; or

(ix) any elective surgical