Critical illness will not pay out

panda78_2

My brother in law has just gone through a lot.
He was diagnosed with testicle cancer and had to have one removed.
He recently contacted his insurance company who he has a critical insurance with and they are giving him the run around saying he's not covered.
We have gone through all his information which clearly states he is.
What do we do about it.
My sister and him have gone through so much and it's upsetting to see them
having to go through more.

olly300

Follow the companies complaints procedure properly and make sure all letters are sent recorded delivery. At the end of each letter state that the matter will be taken to the financial ombudsman if it's not resolved within the timescale stated.

mattymoo

Why have they said he is not covered? Pre-existing condition or condition not covered? Let us know, plus name of company / policy type and someone will be able to point you in the right direction.

Dunstonh is pretty good with this sort of thing.

dunstonh

Until recently critical illness policies were not all the same. Indeed, even now they are not as a number of providers choose to go beyond the ABI minimum standards whilst others do not. Cover also came in budget and comprehesive forms so when someone says they have critical illness cover, you cannot assume what coverage they have.

Here are some stats from Skandia (who have one of the most comprehensive CI policies on the market):

Cancer remains the most common condition, accounting for 51% of claims. This is followed by heart attack (13% of claims) and death claims under critical illness policies at 13% of claims.

Fifty-eight per cent of female cancer claims were for breast cancer. Fifteen per cent of male cancer claims were for prostate cancer, the majority of these (59%) for low-grade prostate cancer. This continues to be covered under all Skandia critical illness policies with a partial payout of the lower of £10,000 and 20% of the sum assured. [note comments below re highlighted text]

In this case, going to complaint is premature. We need to know some factual information.

Was testicular cancer covered on his policy?
Was it classed as low grade prostate cancer (often excluded by some providers)?
What is the reason for refusal?