life and health Insurance

nkyher

when we were at our last house (2003) we swapped mortgages and went through Lloyds TSB. Typically they reviewed home insurance and our death cover etc. We were recommended that for a little more we could have life cover and medical cover in one. Now at this time my husband had a bad back and we were told his back wouldn't be covered. A man from the bank to our home and sold us this life/ health insurance policy.
Fast forward to present day. over the last few years my husband has become ill with a muscle weakness condition and his back has required major surgery. his operation bone wise was successful but his muscle weakness has left him barely able to walk.
We contacted Scottish Widows who looked at our policy and told us all of the disability cover on my husband had been excluded not just his back. We have been lied too. I want to complain, but as my husbands health has deteriorated I fear we wouldn't get any new cover if it were cancelled and just don't know what to think or do about it.

Wutang_2

What is the actual insurance? Its not Health Insurance...possibly critical illness?

And, whats the problem?

lisyloo

We have been lied too

I presume you mean the verbal communication that you are trying to remember from 2003?

What does the paperwork actually say?
Can you prove you've been lied to or are you simply reporting what you think was said over a decade ago?

I want to complain

Go ahead then and make a formal complaint, however bear in mind they won't simply believe what you think was said in 2003, they will go on what you signed (and probably signed to say you have read and understood).

I fear we wouldn't get any new cover if it were cancelled

Pre-existing conditions are not covered - not at standard rates.

and just don't know what to think or do about it

Have you reviewed the paperwork to see what you actually signed and agreed to or are you simply relying on memory of conversations over a decade ago?

If you are not sure, then personally I'd raise a complaint as it won't cost you anything to do so. However as I've already pointed out your memory MAY be incorrect, you also MAY be correct but unable to prove what was said verbally. The paperwork you signed is crucial here and you are meant to have read what you signed and agreed to.
If you don't have the paperwork and want to look at it, then request it.

I don't support superious claims as it costs the industry and ultimately us as consumers money, but if you are genuinely unsure, then there is no downside to you of putting in a formal complain save the time and effort of writing a letter.

kingstreet

nkyher wrote: »

at this time my husband had a bad back and we were told his back wouldn't be covered...

... We contacted Scottish Widows who looked at our policy and told us all of the disability cover on my husband had been excluded not just his back

Could you type for us the exclusion added to the policy to cover this when you were accepted for the cover?

Also, please answer Wutang's question. What cover did you actually take out?

Critical illness cover pays a lump sum on diagnosis of one of a pre-set list of medical conditions

Permanent health insurance pays a monthly income benefit when the policyholder is unable to work due to long-term illness or disability.

Payment protection pays the monthly payments for a credit commitment when the insured is unable to work due to accident or illness, normally for a short time.

kingstreet

As an example, one of my clients had a disc problem and the exclusion for her PHI cover read;-

"I accept that no benefit will be paid under this contract in respect of any disease or disorder of, or any injury to, the spine, its intervertebral discs, nerve roots or supporting musculature and ligaments."

Please set out your exclusion, as requested.

nkyher

Sorry I didn't expect such fast replies. it is a mortgage protection assurance for life, critical illness and children's benefit.
when we moved house the original documents went missing so I asked for them again but only have a summary and I can't find any reference to the exclusion, so can't actually quote it sorry.

lisyloo

Well if you are serious about pusuing this (and I think you need to even if only for your own peace of mind) then you need to obtain this information.
By raising a formal complaint if you need to.

Personally I would feel I needed to do this even if I wasn't convinced of success because I feel it would weigh on my mind forever that I had not done the best for my family if I don't see it through and get closure (I think that's mainly specific to the guilt that women feel about their innate responsibility to take care of everyone).

I would initially request your contract information including specifically this exclusion. If you have trouble getting what you want by simply asking then raise a formal complaint. There are time limits on that and a free an independent ombudsman service available to you, so putting it on a formal footing starts the clock ticking (nothing happens fast but it's a start).

kingstreet

From the information given so far, the only potential claimable event in a critical illness policy would be for total permanent disability (TPD). There are no other musculoskeletal conditions covered by such insurance.

It's possible TPD was completely excluded at the point of underwriting, or a specific exclusion added, such as that mentioned earlier. It is not clear if the condition suffered by the insured would have triggered a successful TPD claim. It would depend on the definition of disability and the severity of the condition.

There may be a more general "loss of independence" definition, where a claim would be successful if the insured was unable to undertake three or six activities of daily living. The only way to establish if this definition is present is from the sales documentation.

You need to obtain copies of the documentation from the sale of this contract;-

Factfind
Illustration
Application form
Recommendation or suitability letter
Acceptance advice terms
Policy document

to enable you to establish exactly what happened here.

Did your earlier policy have any form of illness or disability cover included?

nkyher

Thank you for your replies I will ask again for copies of the original paperwork and come back to this, I do apologise for posting and not coming back to you, my husbands not been well and subsequently going into hospital now for more surgery next week.
Thanks again for taking the time to reply