L&G ASU - my complaint not upheld

magpiecottage

marshallka wrote: »

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.

Sick Pay from an employer will include Staturory Sick Pay and it will show as such on the payslip. After the first few days, it is reimbursed to the employer by the State. If the employer provides full pay, then it will be topping up from its own resources but no employer is going to say "no" to the State contributing.

marshallka

roonaldo wrote: »

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

I have just checked the terms and conditions of the MPPI on offer now at Cardif Pinnacle and it only says

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

I have emailed to query about receiving FULL sick pay (ie what you would normally earn per month - company sick pay) and claiming on their MPPI also.

They will not answer the question at all and just keep referring me to asking what my policy number is. I have said I do not have a policy and that before purchasing I wanted it confirmed to me that whilst if I was off work sick would I still get the insurance paid out alongside my FULL COMAPNY SICK PAY from work which would be the same as my normal monthly pay I would receive for working. I have also asked that they confirm "in additions to any other benefits" and what exactly it means? I cannot help it, I am confused.com

The standard weekly rate for SSP is £81.60 a week.

http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Illorinjured/DG_10018786

I think the correct term for full sick pay is "occupational sick pay" but I have always called it "company sick pay".

I am not saying you are wrong roonaldo BUT why will they not confirm this? Surely people need to know for sure and get it in writing?