Life, critical illness and death assurance

mcintyg

I have been paying as assurance for critical illness, unemployment and death.
Scottish Provident is the provider. During last tree years I had an illness which cause me to loose my job.
I put a claim as an ill person as the criteria for the job I do was such that I was not fit to work.
The claim was rejected.
Then I became unemployed I place a claim as unemployed; my claim was decline because I was not in receipt of income support and was actively seeking employment. I have been paying since 2003 a very healthy premium.
The Ombudsman has been a total disappointment they have not been able to help me as the policy provider has come up with excuses t justify their actions?
I have now tried to complaint as a mis-sold product as it has not met my needs and the Ombudsman has once again allow my provider to give reasons to justify themselves. I have not benefited yet from my policy? do I need to die to see if they will pay something?
Can some one out there help?:(

OshayAway

It's difficult to comment without knowing the facts of the case. It sounds like you probably claimed on the TPD (permanent & total disability) element of the critical illness cover? You don't specify what the condition you suffered is but often TPD claims are not upheld if there is not sufficient evidence to establish that the condition is permanent. Or it may be that you don't have 'own occupation' TPD but rather 'any occupation', 'work tasks' or 'activities of daily living' definition.

The unemployment cover criteria seems very clear, 'cut and dried', transparent and quite standard with these contracts, so I don't quite see where your grievance is with that?

Like any policy, there is criteria set out from the start which forms the basis of the contract. It would appear that you have not satisfied the criteria which is why neither claim has been upheld and that decision has been upheld by the FOS who are know to be biased towards the consumer.

I doubt there is anything else that would change things short of you suffering a more serious condition or given a worse prognosis.

jonesMUFCforever

Without knowing what the critical illness is - how can we comment?

kingstreet

How did you buy this cover?

Why did you choose critical illness, life cover and unemployment cover?

What consideration did you give to disability/income replacement cover?

What illness did you suffer which made you feel you had a legitimate claim?

dunstonh

Lets look at what you have:
1 - life assurance
That pays out if you die.
2 - Critical illness cover
That pays out if you are diagnosed with critical illness (from a list of critical illnesses).
3 - unemployment cover
That pays out if you are made redundant and have signed on and are actively seeking re-employment.

I am guessing that the illness is not a critical illness. So, therefore the CI policy wont apply. However, you need to tell us the illness for us to really offer useful comment.

For unemployment, it sounds as if you have not signed on and are not actively seeking employment. In which case you do not meet the claims criteria.

The Ombudsman has been a total disappointment

The FOS works on facts. You cant claim for non-critical illnesses on a critical illness policy. You will be rejected and no complaint will change that. Same as if you are not signing on and actively seeking employment. You are choosing not to meet a simple requirement to be paid out. It is a fair and reasonable requirement too. So, the FOS will reject you if the facts show no wrong doing by the firm.

jonesMUFCforever

Does it sound like a stress related illness to you?
If so OP won't be covered.

mcintyg

The Condition is Chronic Fatigue Syndrome /Myalgic Encephalomyelitis
This condition has a very extensive spectrum. At the time of the claims I was very ill and unable to carry daily life tasks. I am improving but unable to hold more than a day work routines.

ACG

So it is a condition which is not covered.
With all respect, the name of the cover you have gives it away Critical Illness.
If you had taken out PHI or Income Protection (NOT Unemployment cover), then you would most likely have been in receipt of the benefit.

Its for exactly this reason i prioritise PHI above Critical Illness for the majority of people - it might not be a lump sum but atleast your getting the benefit.

Im not one for claim culture, but did you do this yourself or did you organise cover through a broker? If you went through a broker, have a look at your paperwork see what it says about income protection.

dunstonh

The Condition is Chronic Fatigue Syndrome /Myalgic Encephalomyelitis

It is not a critical condition. So, the critical illness cover will not pay out. You havent died so the life assurance wont pay out.

The problem is that you dont appear to have insured yourself for long term illness.

OshayAway

mcintyg wrote: »

The Condition is Chronic Fatigue Syndrome /Myalgic Encephalomyelitis
This condition has a very extensive spectrum. At the time of the claims I was very ill and unable to carry daily life tasks. I am improving but unable to hold more than a day work routines.

It's as I suspected then as I outlined in post #2. It's not a degenerative condition or necessarily permanent. This is why it's not considered to fulfil the definition of TPD.

The good news is that you may well improve significantly still. A very good friend had particularly severe CFS and could hardly move just a few years ago. She is now very active and even volunteers on community building projects.