Breast cancer and life / critical illness cover

inspectorlund

Breast cancer and life / critical illness cover

Hi all

A question if I may, which may actually be 2, so I have also posted in the Health section.

My partner was last week diagnosed with breast cancer. In August, she had taken out life / critical illness mortgage protection policy. By a brief reading of the policy, she looks to be covered.

However - a complication. In March she had gone to her GP to complain of the lump in her breast. A locum saw her in place of the usual doctor and said the lump wasn't anything to worry about. Only when this same lump started hurting in November or so did she go back to her GP and was immediately referred to the hospital for tests resulting in the diagnosis; the tumour is already 57mm across. It was disquieting in the extreme to be told by the hospital that it wasn't that common for breast cancer to be painful, so if that lump in her breast hadn't started hurting then armed with what she'd been told in March it wouldn't have occurred to my partner to seek a second opinion.

Main question - has that locum screwed up? Second question - if the answer to this is yes, does the above mean she had a pre-existing condition at the time of taking out the policy in August?

Thanks in advance for any thoughts / advice.

ACG

Its difficult to answer. The general rule however is that if you have answered the questions truthfully and correctly to the best of your knowledge - you should be fine.

Yes the locum has made a mistake by the sounds of it. The good news is that it has probably enabled you to get CI cover (although we wait to see the result of any claim) where you would not have been able to had he/she correctly diagnosed it. The bad news is that it has taken longer to be diagnosed.

Call up the insurance company, they will send you a claim form.

If the claim gets refused find out why and ask which question(s) specifically were answered incorrectly and then let us know.

Thankfully I have not had to deal with too many claims (being fairly new to the advising world so I might not be entirely correct). But either way, there is no harm in putting a claim in. When I worked for a life office, someone put a claim in on CI from a broken arm...he did not get a payout but god loves a trier.

InsideInsurance

What did the locum say it was? You really would need to get professional opinion on if the misdiagnosis was "reasonable". I am not a medical expert but if you say it is atypical in the sense of it causing pain then it may also have been atypical in other ways too.

As to the insurance, it will depend on what has been declared to the insurer and accepted by them

kingstreet

Did she disclose the march GP visit on the application?

If she did, the insurer investigated and terms were offered there can be no suggestion of non-disclosure.

There is no "pre-existing conditions" clause in life & critical illness underwriting. You're expected to disclose your full medical history at application, giving the insurer the opportunity to consider and offer appropriate terms.

inspectorlund

All - thanks for responses received so far - always good to get angles we hadn't thought of eg the disclosure of the March visit (do you have to disclose EVERY GP visit, though?!) Will check them out.

kingstreet

There's a specific growths, lumps and tumours question which would have applied in this case, so it would have been disclosed therein, IMHO.

Friends Life, for example;-

"In the last five years have you had any of the following;-

A lump or growth of any kind; or any mole or freckle that has bled or become painful, changed colour or increased in size?"

pinkteapot

Even with a broker, we ended up applying to three different life companies before finding one who'd accept DH. So we've seen a lot of application forms this year.

Firstly, no, she didn't have a pre-existing condition. It would only have been pre-existing if it was diagnosed, which it wasn't.

Key will be whether all questions were answered honestly. All the forms we saw asked for a listing of all GP visits in the last 12 months (with reason and outcome). Some wanted longer than 12 months for this.

In addition, all had the question above re 'have you had any lumps?'.

Did she declare the GP (locum) visit and lump? If yes, it's fine. If no and she was asked, it may come out. Did you keep a copy of the answers given on the application? They usually send you a copy to sign and one to keep.

I'm sorry for the diagnosis.

InsideInsurance

Evidently these things vary between policies but typically you do not need a diagnosis for it to be defined as pre-existing otherwise we could all become ill, buy insurance and only go to the Dr after the waiting period.

The OP however did have a diagnosis, just the diagnosis was incorrect.

inspectorlund

All - hmm. I haven't actually seen the application form, or what my partner did or didn't write on it, but the policy is with Aviva.

ACG

http://www.aviva.co.uk/adviser/life-insurance-documents/view-document.cgi?f=pt01145c.pdf&lid=prod-lit-Term%20Assurance&lpos=pt01145c.pdf - this is the current application form which may be different to form which was in use at the time your policy started but it should give you a good idea of questions asked.

Put in a claim, best case scenario they pay out but you will never know until you do it. Even if the claim is dclined there is nothing to say you can not appeal the decision.

inspectorlund

Have looked at the (Aviva) proposal form and it didn't ask for any details of any GP visits. But yes, it DOES ask 'Within the last 5 years have you experienced.......a lump, growth or cyst of any kind, or any mole of freckle that has bled, become painful, changed in colour or increased in size', to which partner answered 'NO'.

The reason she did this is that, having seen the locum in March and been told it was nothing to worry about, she didn't think it was anything significant. So she may have made a mistake in what she put on the form in August, but definitely did so in an honest belief and in her position I might even have done the same.

Her breasts have always been a bit lumpy and the offending one is, and always was, slightly larger than the other one, so when it started hurting a bit in March and she was told it was nothing to worry about, she merely assumed it was a result of the strenuous physical exercise she was doing at the time. Since March, it's been hurting on and off and only when it started hurting more significantly in November did she go back to her regular GP - and got referred.

Any thoughts?