Critical illness claim against bright grey

DEREK_MACFARLANE

Hello,


I don’t know if this is worth going to a NO WIN, NO FEE COMPANY.

I wonder if you can help me, regarding my critical illness claim against Bright Grey.
I made a claim for acute pancreatitis and removal of gall bladder, and was ill for 6 months between October 2012 and May 2013.

Bright Grey are point blank refusing to listen to me and I have tried to claim via the financial Ombudsman but they say I would have to wait months in a queue for a claim. (Well I have tried this and after 12 months, they say I have no claim)

I was also in ICU for a prolonged time when in the Glasgow Royal Infirmary, so when I looked online to see the cover booklet, I thought I was covered, but the goalposts have changed, since me starting my policy in 2007, paying around £25 per month.

I was never notified by letter, email, direct mail or phone call regarding changes in my policy, if I was aware of any changes and cost implications then I would have taken it onboard, but I heard nothing, so presumed when the worst happened I and my family would be covered.

The Bright Grey document you can download that refers to having critical illness and all the conditions covered. I was never told of any updates and changes to my policy, since starting it circa 2007. If I was made aware of added benefits and added cover, by either phone call, email or by post, that would have been good to know, but was totally in the dark with everything.

So when I was struck down with acute pancreatitis and removal of my gall bladder, I thought I would be covered. I was in Intensive Care for a long time (and nearly passed away) and the cover in the booklet says 10 days, I was in for double that and more, and again they changed the goalposts on the policy. I was on SSP during the 6 months I was ill, and lost out in £10k of earnings, plus I was fighting an overdraft.

All I'm looking for is a fair payment, as they have changed the goalposts in this policy from when I first took this out.

I thought that covering myself and family, would not add stress, but it has, I was forced back to work early against my consultants recommendations due to me struggling financially in March 2013, and since then I have recently been made redundant, so a successful claim would be a bit of good news for a change.

Any advice here, would be grateful.

Thanks

Derek

dunstonh

I was also in ICU for a prolonged time when in the Glasgow Royal Infirmary, so when I looked online to see the cover booklet, I thought I was covered, but the goalposts have changed, since me starting my policy in 2007, paying around £25 per month.

CI condition coverage does not tend to change on existing plans. Only on new plans. i.e. old plans keep the old terms whilst new plans set up after that date use the new terms.

So, what date did you take out the CI cover and what does the coverage guide specific to that version of policy state.

magpiecottage

You may have a valid complaint against the insurer if you can prove that you were covered for the condition you suffered. You need to look at your policy document, not a current version (which the online one will be) as the policy document defines what your one contract of insurance is - and thus what is covered.

You may also have a valid claim that you should have been advised to take out permanent health insurance (long term income protection) in preference to critical illness.

This is because it would have provided an income regardless of the illness. Critical illness is more "sexy" because it has a bigger payout and does it in one go, not "on the drip" - but if, as seems to be the case for you, you are not diagnosed with a specified condition (rather than one which might seem similar but in reality is different), you get nothing.

If so, your complaint would be that you were not given sufficient information about the two types of policy to make a properly informed decision.

Nearlyold

Sorry to hear of your illness, could you be more specific as to what you believe the policy should have paid out for, was it
1)Acute Pancreatitis
2)Gall bladder removal
3)Being in intensive care
4)Being ill and off-work for 6 months

If one of these is listed as a claimable condition (subject to certain criteria) in your original policy documents then the policy should have paid out, if its not listed as a claimable condition then you cannot realistically expect the policy to pay out - even if later policies issued do cover that condition.

Minx1986

I'm confused, if I am right in reading your post you think that Acute Pancreatitis or Gall Bladder removal would be covered under 'critical illness'?

I think you are confusing 'critical illness' with a 'serious illness' and in this case, i believe your circumstances would fall under the later, which i understand is no use to you (but is exactly why the Financial Ombudsmun would not rule in your favour). Criticall Illness covers have generally only improved over the years and looking at the BG booklet online, they still not cover any kind of pancreatic issue.

It sounds like what you actually needed was some kind of 'income protection', paying your income whilst you were unwell.

Check your orginal policy booklet and schedule, but I'm 99% sure, the cover your expecting is not there. On a brighter note, if you have a heart attack or stroke in the future, that probably will be!

Nearlyold

I think its the intensive care bit, as I understand it the OP's policy taken out 2007/2008 did not cover this but later policies introduced 2012 do, and the OP believes the insurer should pay out on his policy.

Insider101

Critical illness policies pay a lump sum on diagnosis of one of a specified range of conditions which should be stated in the original policy document. So vague generalisations like "being in intensive care" or "being off work for six months" won't be stated. Acute pancreatitis and gall bladder removal are specific conditions and might be. But the OP needs to refer to the initial policy summary. If these are covered then the insurer should pay out. If not then they shouldn't.

magpiecottage

Looking at this again

DEREK_MACFARLANE wrote: »

I have tried to claim via the financial Ombudsman but they say I would have to wait months in a queue for a claim. (Well I have tried this and after 12 months, they say I have no claim)

If the Financial Ombudsman Service says no, then you can ask for an ombudsman (as opposed to an adjudicator to consider your complaint.

The Bright Grey document you can download that refers to having critical illness and all the conditions covered. I was never told of any updates and changes to my policy, since starting it circa 2007.

That is because it is the contract currently on sale, not the one on sale when you took yours out.
An existing plan would not change, even if new plans had different terms and conditions.

Consequently, it looks to me like PHI might have been more appropriate than CI - but that would be something to take up with the adviser, not the insurer.