payment protection insurance stopping payments

pinkmum2010

A bit of a long story, my husband went off sick from his job last June, he was diagnosed with Hemiphlegic Migraines and recently with Bipolar disorder. He has insurance which pays out if he is unable to work due to ill health. When he completed the Paper work for the insurance it asked about pre existing condtions and if he had been ill in the last 3 years which he ticked no to. The insurers have since been in touch with his DR and the DR has written back saying that he has had the conditions since he was 19, he last went to the dr's about his mood swings 10yrs ago and the dr said there was nothing wrong with him, he has had headaches in the past 9much like any other normal healthy person) which he has never sought medical help for or missed work due to them. the Dr's claim that he has had these conditions is more in hindsight rather than him being diagnosed back then but due to this letter from the dr his insurance company have stopped his payments while they investigate, so I suppose my question is do they have a leg to stand on?

InsideInsurance

It depends on their exact wordings of the policy and in particular around pre-existing conditions.

Do you know if your policy covers mental health? Many dont in which case it may be just the migraines that are of interest and the prior mood swings/ bi-polar disorder would be irrelevant but if it does then both bits will need to be looked at

pinkmum2010

We'll have to phone them again, they have sent my husband back a copy of his agreement in which he has ticked the box to say that he's had no illnesses in the last 3 years and that's why they are claiming he wasn't up front with them, but at the time he hadn't had any health porblems in the last three years and was not diagnosed with anything prior to that.

thanks again for your reply

InsideInsurance

You really need to look at the policy wording as most of these words will be explicitly defined within the document.

Often pre-existing will be something along the lines of anything where you had symptoms, took medication or sort medical advice on even if there was no formal diagnosis.

If the bi-polar is an issue it would help if the GP had confirmed that 10 years ago an "all clear" or a ceasement of treatment occurred to confirm he was symptom free and therefore would not count as pre-existing by their definition.

On the "headache" front, had he explicitly seen the GP about them prior to the migraines or is the GP trying to be "helpful" by mentioning he had just normal headaches as everyone else does?

I will point out that I dont have the greatest opinion of GPs either in general but particularly when it comes to giving evidence. I have both personal and professional experience of them giving terrible information that has caused major claim or underwriting problems.

pinkmum2010

Just phoned home and he's had another letter saying that they are not going to pursue it as it was obviously an innocent oversight. I think they were just trying to get out of paying because this is something my husband will be claiming for a while until he adjusts to his medication and goes incident free for a while