Friends Life - Sign Petition

wary

My wife recently received this. Another example of how you should ensure that your application is 100% accurate and fully discloses even the most seemingly menial detail ...


Nic was my best friend. He was a hugely talented guy, a fantastic dad and a loving husband. Nic died of cancer in October aged just fourty-four.

Instead of focusing on his family in his last few months of life, Nic was forced to spend it battling his life insurance firm Friends Life over his critical illness policy.

Despite declaring all previous illnesses and conditions, Friends Life cancelled his policy. His wife and kids inherited a needless battle to get what they are owed. Nic wasn’t sure of how this battle would turn out -- but I want to make sure we win it in his memory.

That’s why I’ve started a petition on Change.org demanding that Friends Life pay Nic’s family the money they are owed.

Nic was convinced that he had given them full disclosure and that when they offered him the policy Friends Life had done their checks. To put it simply; he died of cancer but they refused to pay over not mentioning having had pins and needles -- something that had absolutely no connection to the disease that killed him.

His doctor is outraged at the way Friends Life have treated Nic, and has written to Friends Life, saying: "I think it cruel and highly distasteful that two irrelevant details from his medical history have been used as some sort of pretext to deny him a payment on his critical illness policy."

This petition won’t bring Nic back. But it could make a real difference to his family’s future. Please join me in telling Friends Life to do the right thing.https://www.change.org/en-GB/petitions/friends-life-friendslifetalk-pay-out-nic-hughes-critical-illness-policy-nicsfight?alert_id=LGSJQfeIOi_PRGTPAMNRG&utm_campaign=14688&utm_medium=email&utm_source=action_alert

Thanks,

Kester

PS - You can read more about this case http://www.guardian.co.uk/money/2012/dec/03/life-insurance-missing-details?utm_source=action_alert&utm_medium=email&utm_campaign=14688&alert_id=LGSJQfeIOi_PRGTPAMNRG and please help share this campaign with your friends and family by using this link: https://www.change.org/nicsfight

antrobus

My first reaction was, why haven't the family taken a complaint to FOS? But the Guardian report dated 2/12 says they have. Non- disclosure is a frequent issue with critical illness claims and the FOS regularly has reasons to side with consumers. See http://www.financial-ombudsman.org.uk/publications/ombudsman-news/13/jan-critical-illness.htm

So if the FOS is investigating the complaint, why waste time and effort on a petition?

kingstreet

A situation like this is always sad to read about and one would hope is few and far between with insurers paying out on critical illness claims in the high 90%s.

The FOS tends to view inadvertent non-disclosure quite generously. If it feels the policyholder was not deliberate, it often asks the insurer to settle the claim as if it had known about the non-disclosed issues, by deducting the additional premiums which would have been payable from the claim payment.

However, this;-

had they been aware of your full medical history, they wouldn't have been willing to offer you any cover whatsoever

may scupper such chances.

I understand the argument that the conditions which weren't disclosed were nothing to do with the ultimate reason for the claim, but if the insurer would not have offered terms, the lack of connection isn't relevant.

I'll be surprised if the FOS upholds the complaint.

ACG

I dont want to comment on this one way or the other as there is always more than 1 side to every story. I cant imagine what you and your frends family are going thrugh. I genuinely hope you get a payout as i know how important it can be at times of need.

The problem i can see is that your friend thought pins and needles were important enough to discuss with his GP, but not important when it came to applying for the insurance.

As i said, im not taking sides. I dont know enough about the situation.

dunstonh

I'm not going to sign the petition. Whilst I understand the frustration, the FOS guidance on non-disclosure is very heavily weighted to the consumer and is also written clearly and very simple to understand and follow and the FOS use it in any disagreement that takes place. Indeed, it is one of the better things the FOS has done and its a shame it took the FOS to do it and not the FSA. In my view it is more than sufficient and suitable and more consumer biased than the law to be able to resolve this case in a fair way. It is fit for purpose and since its introduction, things have become clearer and fairer and we dont need it meddling with.

I would want to see the FOS outcome first. However, I fear that if you follow the FOS guide, the outcome would be a rejection by the FOS because the medical information disclosed was sufficiently severe enough for the insurer not to have offered terms had they known about it in the first place. The FOS guide covers that point. Plus, the condition was clearly significant enough for an insurer to refuse terms. So, its not some minor ailment forgotten about. The fact he didnt die from that complaint is a mitigating factor but so is the fact that they would not have offered cover in the first place had full disclosure been given.

The FOS guide is here:
http://www.financial-ombudsman.org.uk/publications/ombudsman-news/46/46_non_disclosure_insurance.htm

The last section on inadvertent non-disclosure is where it is going to have a problem is the FOS follow their own guidelines.

pimento

I'd never be able to remember all my separate visits to me GP over my 50 odd years. I don't know why you can't just hand over your full medical records to the insurance company and have that taken as full disclosure.

dunstonh

I'd never be able to remember all my separate visits to me GP over my 50 odd years.

You dont need to. You need to remember last 3-5 years and anything major prior to that. You should be able to remember major conditions and anything recent.

I don't know why you can't just hand over your full medical records to the insurance company and have that taken as full disclosure.

Cost would jump significantly.

wary

dunstonh wrote: »

Plus, the condition was clearly significant enough for an insurer to refuse terms. So, its not some minor ailment forgotten about.

So the insurers says, but we only have their word for that ... it could be that they're just attempting to find a reason for not paying. If the FOS were to conclude that on the balance of probabilities, this up-front disclosure would not have affected the cover/premiums in any way, would that make a difference?

As a separate question, should your insurers opt for a GP report before agreeing to provide cover, and it details something of relevance that you've not disclosed on your application form but probably should have, could they later refuse to cough up for reasons of non-disclosure?

dunstonh

So the insurers says, but we only have their word for that ... it could be that they're just attempting to find a reason for not paying.

They have an over 90% pay out rate. The stats dont support your view.

If the FOS were to conclude that on the balance of probabilities, this up-front disclosure would not have affected the cover/premiums in any way, would that make a difference?

The FOS will ask Friends if it would have made any difference to their initial underwriting decision. The FOS will accept what Friends say as underwriting decisions are documented and reviewed by doctors. It isnt something that is done on the fly.

As a separate question, should your insurers opt for a GP report before agreeing to provide cover, and it details something of relevance that you've not disclosed on your application form but probably should have, could they later refuse to cough up for reasons of non-disclosure?

The insurer doesnt get your file notes from the GP. It asks questions to the GP and the GP replies. Depending on those answers, it will either be enough or require more. It would depend on how much is disclosed.

wary

dunstonh wrote: »

They have an over 90% pay out rate. The stats dont support your view.

I wasn't putting forward a "point of view" but merely a possible conjecture. Your 90+% figure doesn't mean much unless expressed as a percentage of instances where there has been a proven non-disclosure but the insurers still paid as it was deemed non-crucial. It could be that in 90+% of the cases, there has been no identified non-disclosure that the insurers could use, either genuinely or on a technicality.

dunstonh wrote: »

The FOS will ask Friends if it would have made any difference to their initial underwriting decision. The FOS will accept what Friends say as underwriting decisions are documented and reviewed by doctors. It isnt something that is done on the fly.

They'll likely have a written policy that explicitly states that insurance would have been declined had the applicant revealed pins & needles?

dunstonh wrote: »

The insurer doesnt get your file notes from the GP. It asks questions to the GP and the GP replies. Depending on those answers, it will either be enough or require more. It would depend on how much is disclosed.

Let me express my question another way, using a hypothetical example ... if the applicant answers "No" to back problems but the GP states that they have suffered from back problems in the recent past, could the insurer, having accepted the application following GP feedback, later refuse a claim on the basis of a non-disclosure (or incorrect info), whether or not death was related to these back issues?

dunstonh

I wasn't putting forward a "point of view" but merely a possible conjecture. Your 90+% figure doesn't mean much unless expressed as a percentage of instances where there has been a proven non-disclosure but the insurers still paid as it was deemed non-crucial. It could be that in 90+% of the cases, there has been no identified non-disclosure that the insurers could use, either genuinely or on a technicality.

I havent looked for more recent figures but 2009 figures showed Friends rejected 2.1% of claims due to non-disclosure. 92.5% of claims were paid out.

They'll likely have a written policy that explicitly states that insurance would have been declined had the applicant revealed pins & needles?

I suspect pins and needles is not the main problem but the abnormal liver function tests that were not disclosed are the problem. Insurers hate tests. They usually defer the decision for a period (typically 12 months of being clear of symptoms and knowing the test outcomes havent recorded an issue of concern).

Let me express my question another way, using a hypothetical example ... if the applicant answers "No" to back problems but the GP states that they have suffered from back problems in the recent past, could the insurer, having accepted the application following GP feedback, later refuse a claim on the basis of a non-disclosure (or incorrect info), whether or not death was related to these back issues?

It depends on whether it got picked up or not by the person reading it. I dont think it will make any difference though as the problem, using the FOS non-disclosure guide, is that if the insurer would never have accepted cover in the first place, then it doesnt matter if the non-disclosure is innocent or not or mentioned by a third party in notes which would be reliant on a third party picking up. If the condition was linked then you would expect it but if its not linked then the person reading the answers from GP may not give the unlinked condition a second thought. Underwriters are not all doctors. There are doctors available for conditions that require a more specialist view but they tend to focus on specialist areas and they may be asked to give an opinion on that area without being aware of other areas.

Typically the questions asked of the GP are focused on a condition and the GP responses are typically focused back in response.