Questions on MPPI please help

edited 30 November -1 at 1:00AM in Reclaiming Mortgage Fees, Council Tax, etc
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please-let-me-be-luckyplease-let-me-be-lucky Forumite
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Hi all,

Short(ish) version of a long story is that Hubby and I took out a mortgage with Abbey National in 2001, and we were advised to take out PPI which I believed to be unemployment and sickness cover which would pay out the monthly mortgage amount for 6 months should the need arise, and a plan for death or critical illness which would pay the whole mortgage off should either occur. We borrowed more on the mortgage in 2008 and increased the amount we paid monthly to cover new mortgage amount.

Fast forward to June this year and Hubby had an accident resulting in a severe brain injury and a 2 month hospital stay, for which he has been left with long term memory problems amongst other things. I phoned the PPI companies and firstly made a claim on the Critical illness cover. 6 months later they have still not made a decision of whether his injuries 'meet their criteria'! (Does anyone know how long they have to do this and if they say no, do I have a claim for mis-selling as at the time OH was a motorbike salesman and we were convinced we should have it as it was a dangerous passtime and could result in injury. That's exactly what happened but now they are 'unsure if this type of injury is covered'.)
I then found that the other cover was unemployment only, not sickness so I was not able to claim. (Was this mis-sold as I was led to believe it was both?).

Yesterday we found out that his employment will now be terminated due to 'reduced capabilities' (even though he is still off on the sick) so I called to make a claim on the unemployment cover part of the PPI and have been told this is not valid as he is not fit to look for other work at the moment (He wont be signed off until at least March). This then renders the policy useless and I might as well cancel, but would we be entitled to claim any of it back?

I'm sorry this post is so long and fractured but I dont know what to do next. Obviously if the Critical illness cover pays out it will be a different story, but I feel very let down by it all. Thanks in advance for any advice.
Debts @ LBM £23,729.31. Debts @ 08/04/2016 £0 :j
Best win so far - holiday to Florida

Replies

  • dunstonhdunstonh Forumite
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    I phoned the PPI companies and firstly made a claim on the Critical illness cover.

    PPI doesnt offer critical illness cover. That is only available on standalone critical illness policies or as a bolt on to life assurance plans.
    6 months later they have still not made a decision of whether his injuries 'meet their criteria'! (Does anyone know how long they have to do this

    A lot of the time the delays are down to getting information to the insurer from the GP and consultants. Often the information they give needs chasing up and can take some time on borderline cases. Ask the insurer what the hold up is.
    if they say no, do I have a claim for mis-selling as at the time OH was a motorbike salesman and we were convinced we should have it as it was a dangerous passtime and could result in injury.

    Critical illness cover is largely irrelevant to that. It is for diagnosis of critical illnesses rather than accidents. That could well be what the delay is here.
    I then found that the other cover was unemployment only, not sickness so I was not able to claim. (Was this mis-sold as I was led to believe it was both?).

    If that is MPPI then it will be accident sickness and unemployment. Only if it is standalone unemployment policy will it not cover you. Whilst that could be the case, standalone unemployment only plans are not common. Often they are used where a permanent health insurance policy is put in place.

    A mis-sale relates to an incorrectly sold product that you can show was not advised on correctly. It does not relate to a certain event that is not covered because you chose not to have cover in that area. Given you mixing up of the insurance types, it is difficult to really give opinion.
    This then renders the policy useless and I might as well cancel, but would we be entitled to claim any of it back?

    No. Again, it relates to when it was sold and set up. Just because an event isnt covered, does not make it mis-sold.

    I suggest you go back to the adviser that set these up (or a new adviser if you no longer use that one) and get them to run through what you are or are not covered for. It is possible that through the mixing up of policies that you are missing something (such as a bolt on to the life assurance that covers accident and sickness for example)
  • please-let-me-be-luckyplease-let-me-be-lucky Forumite
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    Thanks for your response. Both plans were set up by an in-branch mortgage adviser in what was then Abbey & is now Santander. I don't understand why we were given standalone unemployment cover & not accident sickness & unemployment, although I do remember them asking if we would get sick pay at work. We weren't told to get any other kind of health insurance cover. The critical illness was definitely pitched to us as something we should have in terms of OH & motorbikes although I also appreciate Death cover is something we should have anyway.
    Debts @ LBM £23,729.31. Debts @ 08/04/2016 £0 :j
    Best win so far - holiday to Florida
  • dunstonhdunstonh Forumite
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    I don't understand why we were given standalone unemployment cover & not accident sickness & unemployment, although I do remember them asking if we would get sick pay at work. We weren't told to get any other kind of health insurance cover.

    That seems very strange. Most of the banks only has an "ASU" plan and not a "U" only plan.

    The information you were given, based on what you have said, appears to be wrong. That could well be a mis-sale reason but verbal comments are notoriously had to complain about due to lack of evidence (he said/she said). Documentation is King. You should have been issued with a report telling you why the products were recommended and why potentially suitable alternatives were not. That it is the key document. The report has had a number of names over the years. Suitability Report is commonly used and widely recognised. If you cannot find your report, then ask Santander to provide a copy of it.

    Alternatively, go straight to complaint and hope the report contains errors that you can prove wrong.

    In future, never ever buy your insurances (or investment/pensions) from a bank. Limited product choice, often cut down versions and the most expensive options going. They usually have staff that have less experience and lower qualifications and knowledge. They also have sales management putting sales pressure on them. This is why banks are so prone to mis-sales.
  • please-let-me-be-luckyplease-let-me-be-lucky Forumite
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    dunstonh wrote: »
    That seems very strange. Most of the banks only has an "ASU" plan and not a "U" only plan.

    The information you were given, based on what you have said, appears to be wrong. That could well be a mis-sale reason but verbal comments are notoriously had to complain about due to lack of evidence (he said/she said). Documentation is King. You should have been issued with a report telling you why the products were recommended and why potentially suitable alternatives were not. That it is the key document. The report has had a number of names over the years. Suitability Report is commonly used and widely recognised. If you cannot find your report, then ask Santander to provide a copy of it.

    Alternatively, go straight to complaint and hope the report contains errors that you can prove wrong.

    Thanks so much for this dunstonh, they've upheld my complaint and I'm getting £2300 back! Still waiting for the biggie with the critical illness claim though. Got everything crossed as I chased this up and its with the medical team now who I'm led to believe make the final decision.
    Debts @ LBM £23,729.31. Debts @ 08/04/2016 £0 :j
    Best win so far - holiday to Florida
  • Hi
    I was looking for similar help as well. We set up ASU for my OH and we were entirely transparent with the broker about his current employment, health notes etc. They advised us that the options available to us for cover were significantly reduced due to his health notes. So we accepted this and took out the best policy available. They told us that his injury at the time was excluded for 1year at the start of the policy which was fine. Now 18mths later he has had an accident at work. The injury sustained is on the same leg - they are now claiming that it's pre-existing injury so he isn't covered??? yet we told them, they excluded it for a year AND this is a brand new injury - similar to breaking your arm twice scenario. The broker we used sold us Select & Protect - they then referred us to First Assist - who have now referred us back to S&P. Very frustrating as the policy seems worthless. What is my route to complain and take this further? I feel totally unsupported as there is no clear path as to who has accountability for this. Hope you can help.
    thanks
    Should also add - policy documentation which I read religiously does not state he is not covered and that a new injury from a new accident is covered.
  • dunstonhdunstonh Forumite
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    they are now claiming that it's pre-existing injury so he isn't covered??? yet we told them, they excluded it for a year AND this is a brand new injury

    Normally pre existing conditions are excluded. Some will be forever. Others will be one year from the last point there was an issue (some conditions never recover and are therefore always excluded. Others do recover).
    What is my route to complain and take this further?

    Interesting as the broker probably has done little or nothing wrong and is correct. It sounds more like you are unhappy with the claim response rather than the sale of the product. If it is the latter, then you complain to the insurer about their claim response not matching what their policy terms state.

    My immediate concern would be how could an accident be classed as a pre-existing condition? Unless the current injury only occurred because of a pre-existing injury could I see them possibly argue that. i.e. the bone was weakened and the break was in the same place. If the break is in a different place then how can it be linked?

    Can you clarify the injury and the why they have rejected the claim? Hopefully they have told you more than just saying it was pre-existing.
  • magpiecottagemagpiecottage
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    From what you say, it seems that the broker has explained the restrictions on the policy and therefore discharged his obligations to you properly. I therefore do not see a valid complaint against him.

    The contract of insurance is with the insurer (i.e. the underwriter).

    The policy key fact is online here. It says you can complaint to

    Customer Relations Team:
    FirstAssist Insurance Services Limited
    Customer Relations Department,
    1 Drake Circus, Plymouth
    PL1 1QH.

    or e-mail to [email protected]

    I would e-mail if I were you. That way you have immediate evidence of receipt and the 8 weeks to investigate start.
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