refusing a Claim for a terminal illness

shootdown1

A friend of mine has a terminal illness and is on the list for a transplant .Earlier in the year he submitted a claim to his insurance company; this was rejected on the grounds that as he is on a transplant list he is not terminally ill.
Has there been a court or ombudsman ruling on this conundrum?

kingstreet

Is he claiming for terminal illness on a life policy, or under one of the definitions of a critical illness policy?

Are you defined as terminal, if a transplant can save your life? I suspect not.

Not much here;-

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/13/jan-critical-illness.htm

stephenni1971

Claims for terminal illness are usually based on the agreement of the claimants consultant one the Chief Medical Officer if the insurer that the claimant has less than 12 months to live.

In addition is not uncommon for the terminal illness cover to cease 12 to 18 months before the end of the policy.

dunstonh

A friend of mine has a terminal illness and is on the list for a transplant

Logically, if your friend is on the transplant list then they are not terminally ill. A transplant would indicate recovery is possible. Terminal illness is typically where the medical officer has stated that life expectancy is under 12 months.

If your friend had critical illness cover, then its possible this could fall under that. However, the insurer response suggests CI cover is not part of the plan. Worth checking just in case.

shootdown1

He has less than 6 months to live without a transplant.
If no transplant is available in time and he dies as a result of his terminal illness, can the original claim be reopened?

kingstreet

Is this a claim for terminal illness benefit under life cover, or a claim for a particular condition in a critical illness policy?

dunstonh

If no transplant is available in time and he dies as a result of his terminal illness, can the original claim be reopened?

If he dies then the life assurance would pay out. All TI cover does is allow it to be paid out potentially up to 12 months earlier.

Are you perhaps mixing up Terminal illness with critical illness cover?

shootdown1

The claim was for a terminal illness, on a life policy, made 18 months before the end of the policy.

marathonic

There's no need for the bolded writing which you may, or may not, be aware is akin to shouting on a forum.

The previous responses are valid. It's highly unlikely that your friend meets the terminally ill definition as per the insurance policy given the fact that they are on the transplant list.

You seem to think that the possibility of death without the transplant entitles them to a payout. If that were the case, anyone that ever needed a liver/kidney/heart transplant or similar would be able to claim on their policies. This is NOT the case.

magpiecottage

For an illness to be defined as terminal there must be no known treatment which could keep them alive.

I'm afraid that is not the same as saying there is no treatment available to the patient that could keep them alive.