critical illness help!!!

jonsdad

Can somebody please help me out?...on a dmp so last thing wanted was heart prob,firm doesn't pay sick so in dire straits...
Got policy with swiss life/ Phoenix...I have had ascending aortic graft and valve replacement,the policy covers me for both,but the graft needs to have been emergency(was told needed doing asap but not emergency!!!)and policy just says valve surgery on advice from consultant,so am I right in thinking if claim for latter should be fine?...just don't trust ins co's any more...and need money...just worried they won't pay out...

InsideInsurance

Insurance companies predominately rely on the information from your doctors/ consultants and unfortunately not all Drs think too hard before writing their reports.

There was another example in the Insurance forum from someone who's doctor stated that the cause was possibly due to alcohol consumption which is an exclusion but the doctor really said he didnt know what the cause was. If he'd put that in the report that instead of alcohol the claim would probably have been accepted.

Ultimately need to see the exact terms but really its down to the doc

pmduk

Unfortunately from my experience dealing with PMI claims, most Doctors erroneously consider themselves experts in medical insurance. I've seen many claimants lose out because of their Doctor's actions.

jonsdad

Thanks for replies,the main problem is I can claim for two things,a graft or valve,the valve is legitimate because its been fitted and I have a cardiologist and cardiothoracic surgeon who know this,I have spoken to their secretary and she assures me that the info I have given ins co is from the medical records written by said specialists,hopefully the two specialists trump the doctor so to speak,as the doctors always say"what does your specialist think?".....the fact is I have had a valve fitted so hopefully I will get paid...maybe I'm being naive to think an insurance company has no intention of paying out any claim,I will let u know the outcome...after all the policy states "a valve fitted on the advice of a consultant" he advised me,I had it done,fingers crossed.

opinions4u

Over 90% of CI claims are paid in full.

InsideInsurance

jonsdad wrote: »

maybe I'm being naive to think an insurance company has no intention of paying out any claim

You wouldnt be unique in thinking this. The payout rates are high though and that takes into account very spurious claims as well as with its poorer cousin ASU/ PPI the terrible miss selling that went on.

If you've had two conditions and one is covered then the other is irrelevant just as long as the Drs remember to state both and dont put anything silly on the forms.