Terminal illness - insurance setting

beanybop

Hello

I have a problem with a terminal illness claim in that the insurers are deciding that the illness was terminal at the point of diagnosis, when at that time the life expectancy was given as 2 years.

My understanding (was and) is that the insurers pay out on life expectancy of 12 months or less.

We waited until the first year was up, and being sensible money savers, we availed ourselves of the policy's guaranteed insurability option increase in the interim.

The insurers are now saying that they will meet the claim based upon the sum assured at the time of diagnosis. (14 months ago)

I maintain that the condition was not terminal in respect of the way that insurance companies mean terminal and that therefore they would not have met the claim a year earlier.

When asked whether the the claimant was now (this is the problem area) considered to have a life expectancy of 12 months or less The consultant has said yes -
(and remember we are at present almost 14 months from diagnosis .)
but the insurance company has decided to interpret the now as being from the date of diagnosis rather than when the form was completed a couple of weeks ago.

Of course we have declined their kind offer, and have told them that we would be better off to wait until the death occurs and get the full payout.

Are they trying it on?

Look forwrd to hearing any thoughts or opinions on this one

Karen

dunstonh

Date of diagnosis is the norm with most of these things.

beanybop

Not what I wanted to hear, but thank you for your prompt response.

beanybop

Update:-

Insurers have agreed to pay value as at date of claim rather than date of diagnosis.

I hope that this news may help someone else in the future argue for what is right in their particular circumstances.

If you have ane expensive life policy with additional features, and are given a longer prognosis than 12 months it is worth thinking about your options with regard to increasing cover ( legally and with disclosure of material facts) in the time before the final 12 months.

Thanks for looking

dunstonh

Good news that. Did they give a reason for the change of mind? Insurance companies are often reliant on doctors reports. In the past, I have had underwriting decisions overturned once clarification or corrections from the doctors have been obtained. I suppose there is no reason why to think it is any different when it comes to claims.

beanybop

Hello

The decision was amended due to clarification of the doctors comments. The form had asked for date of diagnosis and then if condition was terminal, and the insurers took the two things as tied together. The doctor meant that the 12 months or less was from date of signature rather than diagnosis, and once that was understood, with a follow up letter they agreed to pay

Thanks

Karen