Complaint about Cardif Pinnacle Mortgage Repayment Insurance

Judo_Col

Hi

I have used the site before and found it very useful, so thought I would come back here again...

I have submitted two retrospective claims, one for when I was off work with stress, anxiety, depression and knee surgery following looking after my father during his terminal illness and death during and going through family court to gain access to my son, I was off work from September 2010 to December 2010.

The second, was a further claim for stress, anxiety and depression last year from June 2010 to September 2011 as I replased from a breakdown of a longterm relationship.

There is a condition in the insurance which states the following:-

The terms and conditions of your policy exclude "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 a Consultant Psychiatrist Specialist)".

The facts are that I was signed off by my GP and was under the care of the GP, I was referred to counselling at my GP surgery and placed on medication during the first claim but due to delays in NHS etc it never happened so ultimately I went private and was treated at a later date, this has all been documented on my records and been sent back to Cardif Pinnacle along with the documentation from my employer, but Cardif refuse to pay the first claim but have paid the second.

I've complained to Cardif in the first instant and have complained to the FSA, just how ill do you have to be in order to have your claim paid? I was off ill for genuine reasons.

I have been passed from pillar to post, they have misled me, told they need further information when they have written to my GP and said that they don't etc, it's been nothing but a jumping through hoops stressful exercise etc etc

Any help would be appreciated.

opinions4u

The terms and conditions of your policy exclude "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 a Consultant Psychiatrist Specialist)".

If your GP isn't a Consultant Psychiatrist Specialist, and they won't be, your claim won't be paid. Unless ...

ultimately I went private and was treated at a later date

Was this treatment provided by a Consultant Psychiatrist?

Judo_Col

opinions4u wrote: »

If your GP isn't a Consultant Psychiatrist Specialist your claim won't be paid.

I was referred but delays prevented me seeking NHS treatment so went privately, the referral is documented on my medical records.

I have never heard of a policy that requires that for stress.

kingstreet

Judo_Col wrote: »

I have submitted two retrospective claims

I must confess I stopped reading when I read this. Can you clarify the claims process in your policy documentation and if it allows you to claim retrospectively?

In my experience, claims for being unable to work have to be investigated during the episode causing the claim.

The recognised complaint route means you should allow the insurer an opportunity to investigate and to reach a final conclusion which it should communicate to you within 8 weeks.

At that point, if you remain unsatisfied, you have the right to escalate the complaint to the Financial Ombudsman Service for resolution. The FSA does not handle complaints of an individual nature, so concentrate on the FOS when appropriate.

opinions4u

Judo_Col wrote: »

I was referred but delays prevented me seeking NHS treatment so went privately, the referral is documented on my medical records.

But you were never under the care of ...

Most referrals get you to a psychologist.

I have never heard of a policy that requires that for stress.

Since around 1999 I've never heard of one that doesn't have such a clause.

Judo_Col

kingstreet wrote: »

I must confess I stopped reading when I read this. Can you clarify the claims process in your policy documentation and if it allows you to claim retrospectively?

In my experience, claims for being unable to work have to be investigated during the episode causing the claim.

The recognised complaint route means you should allow the insurer an opportunity to investigate and to reach a final conclusion which it should communicate to you within 8 weeks.

At that point, if you remain unsatisfied, you have the right to escalate the complaint to the Financial Ombudsman Service for resolution. The FSA does not handle complaints of an individual nature, so concentrate on the FOS when appropriate.

I've started the process with the FSA, when I made my second claim I asked if I could make a retrospective claim and they said yes.

Judo_Col

opinions4u wrote: »

But you were never under the care of ...

Most referrals get you to a psychologist.

Since around 1999 I've never heard of one that doesn't have such a clause.

The waiting time was longer than 4 months, hence making the private referral myself.

Judo_Col

opinions4u wrote: »

If your GP isn't a Consultant Psychiatrist Specialist, and they won't be, your claim won't be paid. Unless ...

Was this treatment provided by a Consultant Psychiatrist?

Ultimately yes. I relapsed and then I was under the care of the psychiatrist.

dunstonh

I've started the process with the FSA

The FSA do not deal with consumers. Anything you pass to the FSA will be forwarded onto the insurer.

Judo_Col

dunstonh wrote: »

The FSA do not deal with consumers. Anything you pass to the FSA will be forwarded onto the insurer.

At what point can I engage the FSO?

kingstreet

Judo_Col wrote: »

I've started the process with the FSA, when I made my second claim I asked if I could make a retrospective claim and they said yes.

I'm confused now. Are you talking about making claims, or making complaints?

Let' say you fell ill, then waited for six months before you made a claim to the insurer. That's a retrospective claim. Is that what you did?

If you fail in your claim, you make a complaint to the insurer. After eight weeks it can't satisfy you, so you escalate the complaint to the Financial Ombudsman Service. Is this what happened?

Where does the FSA come into this?

If you've complained to the FOS, where are your complaints upto?

Cardiff refuse to pay the first claim but have paid the second

So this was a claim, rather than a complaint?