Group Income Protection Insurance - Declined Claim

MrsRosemead

Has anyone out there had any dealings with a company called UNUM? Particularly have they had long delays whilst their claim is being considered?

ACG

Have they declined it or taking their time reviewing it?
Ive not had any dealings with them.

MrsRosemead

Thanks, they declined the claim, I have appealed and they have subsequently declined it again, although giving different reaons from the first. I am now preparing a letter of complaint but having looked at the internet, this company is, I understand of US origination and they do not have a good reputation when it comes to accepting liability.

jonesMUFCforever

Get their final response - if you are not happy you can take it to the ombudsman.

Wutang_2

MrsRosemead wrote: »

Thanks, they declined the claim, I have appealed and they have subsequently declined it again, although giving different reaons from the first. I am now preparing a letter of complaint but having looked at the internet, this company is, I understand of US origination and they do not have a good reputation when it comes to accepting liability.

You need to be a little bit more vague....:eek:

kingstreet

UNUM took over NEL Britannia, the most specialised PHI insurer in the UK (at the time) in about 1990.

http://www.highbeam.com/doc/1G1-9047338.html

ACG

Without knowing more info its difficult to say whethter you have a case or not.

On group phi im not sure you have to answer medical questions or not, so i doubt its down to none disclosure. Which means its very difficult for them to avoid having to payout - but without knowing more it is very difficult.

magpiecottage

I agree. Group PHI is generally underwritten without the need for individual disclosure.

Realistically, your "appeal" amounts to a complaint in its own right. They have eight weeks from receiving it to resolve it to your satisfaction or you can go to FOS.

If you are writing again remind the of this and when the 8 weeks expire.

weighty1_2

ACG wrote: »

Without knowing more info its difficult to say whethter you have a case or not.

On group phi im not sure you have to answer medical questions or not, so i doubt its down to none disclosure. Which means its very difficult for them to avoid having to payout - but without knowing more it is very difficult.

magpiecottage wrote: »

I agree. Group PHI is generally underwritten without the need for individual disclosure.

Realistically, your "appeal" amounts to a complaint in its own right. They have eight weeks from receiving it to resolve it to your satisfaction or you can go to FOS.

If you are writing again remind the of this and when the 8 weeks expire.

The need to complete a medical questionnaire is dependent upon the size of the scheme. UNUM, if memory serves me correctly, offer a free cover level (FCL) of £3,000 per scheme member, provided there are more than 5 members. In this instance cover even in the event of non-disclosure you would expect a payout to at least the FCL since this is an amount which they guarantee to cover an employee for. This leads me to believe the issue is likely to be that below.

It may simply be that the OP does not match the definition of incapacity. UNUM allow schemes to be set up on an own OR alternative occupation basis if the employer wishes to keep costs down. (they actually allow a combination of the 2 as well)

If UNUM think and can prove there is an alternative occupation to which the OP is suitably trained, qualified and experience then they are within their rights to cancel.

OP, can you provide more information on why you are off work and what UNUM are saying is the reason for the declination?

longtimelurkersam

UNUM are one of the most aggressive claims handling companies in this market.

You don't need to say so on here, but if your income is high and therefore so is your potential monthly benefit they wouldnt have had the final decision on your claim, it would have gone to their reinsurers as even insurers need to be insured.

Personally I would do a Subject Access Request under the Data Protection Act. This will get you everything you need to understand the decision including their assessment notes/reasoning and any influence from say their reinsurance company. Any medical papers would go to your doctor, but the claims assessment notes/summary sheets will give you what you really need.

By the way the FOS looks down very unfavourably on IP insurers finding "new" reasons each time an appeal is successful. They should give ALL reasons for declinature at the same time, but many still do not do that. Your "file" will show all the things that they think they can get you on.

As advised make an complaint, get it in the system and get it to the FOS. In meantime get a copy of their papers.

Oh and I would also complain to your employer about it.