The Great 'How do insurers decide whether to pay out?' Hunt

mjwalshe

silverfoxuk wrote: »

One broker markets themselves as specialists in helping those with 'conditions' get insurance by speaking with underwriters on your behalf to see what (if any) loading would apply. I have never dealt with them so have no idea if they are good or bad, but they have a blog which is reasonably informative:
http://www.theinsurancehelpline.co.uk/blog/
A good IFA would of course offer the same service.

Thanks for the mention :-) I work with the guys at theinsurancehelpline on their blog and website - glad to see that you found it useful.


They are a specialised broker they do a lot of high risk and key man type of insurance as well as the pre eisting condition type i belive they where the first to offer HIV insurance.


Rgds Maurice

johnedwards3005

johnedwards3005 wrote: »

Fascinating reading in this thread - but I agree that it provides a disproportionately worrying picture. I've had several successful claims over the years on all types of insurance and I'd say that the key is (as with all contracts) to read the wording carefully - both while buying the policy and again when contemplating a claim: you can expect the insurer's actions to be governed by the precise wording - and you should insist that they do so if they try to short-change you (as they often seem to - I had a cheque today for a supplementary amount 'apologising for the oversight'!).
Perhaps I could seek an insider's view on particular problem I'm having at present, although it's small beer compared with some of the stories posted. Having had a claim paid under my annual travel policy for the last-minute cancellation of a weekend break in Bratislava, arising from an emergency heart procedure three days earlier, the insurer deducted the airport taxes and charges from the Ryanair 'cancellation invoice' (which took ages to get from Dublin) on the basis that they were recoverable from the carrier. Following their advice, I wrote again to Ryanair three times (including recorded delivery) but have received no response at all. As more than three months had passed, I reverted to the insurer (or, rather, their claims handling agents) claiming the deducted amount, as the policy wording says that I am entitled to compensation 'for the financial loss suffered', with no mention of potential refundability. Although this met with immediate rejection, I am persisting by asking that it should be referred to management.
Bearing in mind that nowadays the taxes and charges can make up the majority of the cost of a no-frills carrier's flights (plus Ryanair's well-known reluctance to incur any cost they aren't forced to - and lack of UK contact point), can anyone say from experience what the normal practice is in such circumstances?

UPDATE - Having persited with the insurer's claims agent without success, I asked for the claim to be referred to management (ie to initiate the dispute process). This had the result desired (full payment) - with the explanation that the insurer felt that the circumstances merited payment (without prejudice to future claims!).
Proves my earlier point!!!:j

mattymoo

johnedwards3005 wrote: »

UPDATE - Having persited with the insurer's claims agent without success, I asked for the claim to be referred to management (ie to initiate the dispute process). This had the result desired (full payment) - with the explanation that the insurer felt that the circumstances merited payment (without prejudice to future claims!).
Proves my earlier point!!!:j

I think being caught between an insurance company and Ryanair qualifies as being between a rock and a hard place

mich_city

hi all..

a relation of mine has critical illness cover on his house in ireland, he worked in the construction industry and on the way home from work one day had a blackout in his car... he was told it was a heart problem, then this changed to severe epilepsy.. he has no pre existing problems with either of these and infact has never been ill, other than the expected colds and flu etc..

he has lost his job, got no sick pay from employer and now the critical illness cover on his mortgage has been refused as 'epilepsy is not on our list of critical illnesses' - as you can imagine he is at his wits end..

he is 40, his GP and consultant at hospital are both outraged this has been refused and have stated they are more than willing to fight his corner if it would be helpful..

is it worth him pushing this or just to accept their decision as final?

any suggestions or advice would be great..

thanks

dunstonh

is it worth him pushing this or just to accept their decision as final?

epilepsy is not a critical illness. You cannot expect an insurance company to pay out on something which is not covered.

he is 40, his GP and consultant at hospital are both outraged this has been refused and have stated they are more than willing to fight his corner if it would be helpful..

With respect, there isn't much logic in getting outraged at an insurance company refusing to pay out on something that isn't covered.

Critical illness covers critical illness. If he wanted a wider ranging cover for all illnesses then he should have considered permanent health insurance.

mich_city

dunstonh wrote: »

epilepsy is not a critical illness. You cannot expect an insurance company to pay out on something which is not covered.



With respect, there isn't much logic in getting outraged at an insurance company refusing to pay out on something that isn't covered.

Critical illness covers critical illness. If he wanted a wider ranging cover for all illnesses then he should have considered permanent health insurance.

thanks for the answer... he has been told by numerous consultants the type he has is 'critical' and can no longer work... this isnt something he's had in the past, and not an illness you'd suddenly expect to develop at that age... is a grey area i guess.. it is 'critical' to him.. just not in the eyes of the insurers?.. just wanted a few other opinions as I suspect he has no chance of being paid out personally, but was worth trying on his behalf... just in case!

cheers

dunstonh

thanks for the answer... he has been told by numerous consultants the type he has is 'critical' and can no longer work...

Insurance companies work to a list of illnesses that they cover with CI. Some may cover Epilipsy. Some may not. CI is available in budget and comprehensive versions as well which many people do not realise. Until recently there wasnt a standard list between providers. You could find one with a list of 40 items and another with a list of 13.

If its on their list, they should pay out. If its not on their list they have no reason to.

has been refused as 'epilepsy is not on our list of critical illnesses'

And that is your reason.

mich_city

dunstonh wrote: »

And that is your reason.

no worries, i'm not an expert in these matters so just thought i'd ask...

elvis_girl

anyone know how likely buildings insurance is to pay claim for subsidence and what their criteria is?

FlameCloud

It depends what has caused it, when it started and how the damage has progressed.

You really need to tell them to decide.