Critical Illness Mess

sniperfox

This is my first post so please bear with me..

to paint a picture: My wife and I are in our 40's

My wife has contracted breast cancer in April 2012. It is in situ and high risk. Fortunately the surgeons have removed the cancer (all 73 grams of it) and she has undertaken three weeks of radiotherapy - next is the tamoxifen..

My wifes employer has been less than understanding and have not been paying her whatsoever through the course of the examinations or treatments. SSP only (which is taxed???)

We wrote to the insurance company to make a claim on the critical illness policy in November. This was turned down on the fact that the insurance company decided surgeons report made out that the cancer wasn't high grade or a risk.

We called the insurance company in question with our copy of the surgeons report and clearly pointed out their error in the oversight. (how this was an oversight is beyond me)

This was met by a lady saying please forward this information highlighting these points and there should be no reason for a non-payout. As much as we can say, it seems our luck had changed.

We then received a letter from another member of staff from the insurance company stating that their colleague has made a mistake and shouldn't have raised our hopes. the decision to turn down the application still stands!!

This has been a terrible ordeal and my wife feels severely punished for having cancer, this surely isn't right? We have paid in all good faith for this policy and buried in the small print, it seems you aren't actually covered for anything?

To top this, there is now no way to get any other insurance. The policy doesn't cover either of us for much at all.

yes you have had cancer, no, we are not paying out, and yes you will be charged a premium to cover yourself further???

The long and short was only that we have to pay for corrective surgery for my wife following this year.. we were only expecting a partial payout if that...

I can't even begin to tell you the issues my wife has had with her employer! Why is Cancer so punishing? Please don't point us down the MacMillan route as this has been tried. They are great for catering for children and terminal issues, but we personally found they know little about supporting breast cancer sufferers...



Amy idea's or thoughts are welcome. We are so depressed and stressed with this ordeal...

ljonski

I don't have any solutions as i know nothing about insurance,but i want to say a few things:
I wish you every blessing for you and your wife and pray that things will work out well in your and her health issues.
2)
3) who is your insurer ? Do a search and see if similar problems have come up here or elsewhere.
4) What about the insurance ombudsman?
Every Blessing Lj

sniperfox

Thank you so so much x that means a lot

I'm not sure what the rules are about publishing the insurance companies name on here so left it blank, but it is one of the larger companies whereby their name starts with the last letter in the alphabet... (can I say that?)

We have written to the Ombudsman and await their verdict. Fingers crossed.

It now turns out that my wife has to sacrifice her holiday from last year (7 days) to be paid and a further number of days will need to be taken from this year also. The company she works for has paid her in December by mistake. This was eaten up by the banks arears. Now she has had her January payment removed and still owes a further ammount from the next three payrolls. Doesn't get any better...

ljonski

There are no rules about publishing the name of the insurer here. Maybe post a similar thread on the Insurance thread. The internet is your great help here as you do your own research - you never know what you may come up with. For instance there are bound to be templates and advice for those who are contacting the Ombudsman. HTH. Don't forget to name and shame the insurer!

movingon

I am really sorry but the terms and conditions of Zurich's CI policy (and I am assuming it is them) state that they do not pay benefit for these types of cancers:non-invasive;– cancer in situ;– having either borderline malignancy;or having low malignant potential.

On the other hand, if this is your wife's situation in terms of her tumour, this means that prognosis for recovery is good and return to work should be expected in the near future. I know it is extremely stressful for you both and you can do without the horrible attitude from the employer. Dont dismiss Macmillan. They might not be able to help you with your insurance issues, but they can help with general financial advice, and more importantly, with moral support. Have you heard of Maggies? They are a charity which offer moral and emotional support, and you cannot underestimate the effect stress has on these cancer, so I would suggest you get all the help you can.

Also, if you cannot claim now on the CI policy, it does not make the policy worthless- you can claim if you fit eligibility on another occasion.

Good luck and lots of hugs to you both.

bitsandpieces

Insurance companies have a reputation for being hard to extract Critical Illness payments from You may get more advice if you post on the insurance board, but I would imagine that speaking to an organisation like CAB/Maggies/Macmillan - for advice/support with the insurance, and also a more general financial/benefits review if money is tight - would be helpful.

While the insurance company might be being a PITA, it's worth pointing out that it's likely to be in your wife's interests to retain the critical illness policy (along with any similar policies) with them for now - she would struggle to get this type of insurance elsewhere, given her diagnosis.

Hope that all works out well for your wife.

kissjenn

Hi,

I'm so sorry you and your wife have had this experience.

I think from reading your post there are a number of issues and maybe by separating them out a little things will seem brighter. I'm not a doctor but know a little about it and hopefully can allay some of your fears.

Firstly, your wife has had a terrifying diagnosis followed by treatment which is painful and distressing. You have had to support her through that and you can't make those feelings go away for her. That makes it doubly hard for you both. The good news is DCIS is non-invasive. On many occasions I know they don't operate because it is very unlikely to spread or metastasise. That gives her a wonderful prognosis for the future.

Secondly, your wife's employer has been difficult to deal with. She can check her contract to see what sick pay is available and see if she can arrange payment for hospital appointments. Most employers are pretty good for this. If they are sticking by the letter of the contract then hopefully she can start back once the radiotherapy is over and she's feeling stronger. It can leave you very tired. WOuld they consider a phased return to work?

Thirdly, the CI cover. Because DCIS is so contained and can be left the insurers exclude it. I've checked a couple at random, Legal and General and Aviva...they would also not have paid out.

Unsurprisingly all of this appears to be combining to really stress you both out. Bizarrely the CI result is actually good because it means the cancer was contained and completely cureable. The work is being a pain but she should be able to go back pretty quickly and you can both start to put this behind you.

Macmillans, Maggies, Breast Care UK, Breast Cancer.Org (an American site with lots of Brits) on can all help. Sometimes you just get a pants person on the phone and that can be soul destroying.

I hope your wife is feeling a little better now the ops done and you feel more sure and comfortable that she'll be around for a long time to come. If I can help in any way just PM me and I'll happily share what I know about support resources.