Self-Employed Sickness Insurance

kellemar

Hi there, I'm not sure if anyone can help me with this but thought I would give it a go.

My husband is self-employed and fits kitchens and bathrooms. He has been with the same insurer since 2007 for accident and sickness insurance which is like an income replacement insurance giving you a specified weekly amount if you cannot work due to accident or sickness. It has a 2 week excess on it.

He was fit and well with no time off until early 2009 when he needed shoulder surgery. This went very well, but he developed a serious condition whilst recovering which, despite having up to 48 tablets per day, the consultants could not control. He got very ill and was in and out of hospital for months. In December 2009 he ended up having major life-saving surgery and he was off until May 2010 when he returned to work again.

During this time, we submitted two claims - one for the shoulder surgery and then a second for the following illness. Each time we had to pay £35 for a medical report from the GP and then await their advice as to whether they would pay. Following his shoulder surgery, they paid out about 6 weeks after the claim and then when further certificates were submitted, they paid again.

For the second problem, we had to jump through hoops as they would not accept consultant letters as verification of the illness. It took them 16 weeks to pay out initially on this claim and then after a further 3 months, they wanted another medical report from the GP and then they wanted copies of all his medical notes from birth.

Everything went well after he returned to work - he got straight back into it and following an appointment with his consultant in October 2010, they advised that they needed to do a little bit more surgery to remove a piece left inside or he could opt to have his operation reversed. He chose the latter and he was told it would be in the New Year.

He then developed a problem in his wrist in December which meant it was extremely painful to move and on seeing a consultant, was told he needed surgery to correct a ruptured tendon which would require pinning and plating his arm. He was very unhappy but had to do it as he couldn't work. He had this done in February 2011 and again, the insurers requested everything from the GP. They paid out after 8 weeks.

Stage 1 of his 2 part reversal surgery was in April and all went well and he was discharged after a week. However, complications set in with obstructions and he was admitted to hospital as an emergency again for a week. Things seemed to settle and he was discharged, but he was still very unwell, losing weight rapidly and very weak. In May the Consultant brought the second operation forward as an emergency to complete it and resolve the problem of obstructions.

The insurers were very unhelpful. Despite phone calls and e-mails, I just kept getting "the underwriters are reviewing the notes". In the end, they came back and declined payment as it was a "pre-existing condition". We argued the fact that it wasn't and that he had been covered since 2007. They said it was pre-existing from the point of renewal (September 2010).

This confused me as I have various other insurances, including pet insurance, which continue to cover you for as long as you are with them, but if you jump ship for a cheaper premium to someone else, you won't be covered as it's a "pre-existing condition" then. Their response was that pre-existing conditions are anything that existed 2 years prior to the annual renewal date. I tried arguing this to no avail - they just wouldn't cover him. Therefore from April to July, he had no income.

To add insult to injury, renewal date is approaching at the end of the month and our broker has written to us to say that the insurer is not prepared to provide renewal terms due to the claims history.

I'm angry and confused about this. Firstly, I don't think they are right with their pre-existing condition statement and secondly, I think this is likely to mean my husband won't get cover for if and when he is unwell in the future.

Would anyone happen to know whether any of this is right or wrong? Sorry for being so wordy, but I felt it was best to give the full story.

Thanks very much.

dunstonh

He has been with the same insurer since 2007 for accident and sickness insurance which is like an income replacement insurance giving you a specified weekly amount if you cannot work due to accident or sickness. It has a 2 week excess on it.

This sounds like a budget PPI version rather than full income protection. That is why, I'm afraid, you have had issues in the later claims. A proper income protection would not have had those issues. However, it almost certainly would have cost a bit more when you took it out.

There are two main types of income protection. One is a payment protection and is a budget option for covering short term periods. The other is called permanent health insurance and is for long term illness. The name includes "permanent" as the insurer cannot cancel cover once commenced and it does not renew. There are some hybrid plans which can fall in between these two and a couple of unconventional plans from small door knocking companies with all sorts of unusual options and restrictions.

Who is the product provider and what is the product name?

kellemar

Hi there, thanks for your response. It is a full Accident & Sickness policy provided for tradesmen by Allianz. It is basically income protection, not PHI and has a lump sum element to it too. It wasn't cheap insurance running at around £800 per year.