Group Critical Illness Insurance Claim - Help needed

moneyhlpr

Apologies, the main post is deleted as no longer required.

Quentin

You can if course pursue all options

The most important one will be the FOS - also cheapest as no cost to you, and they can force the insurer to follow their decision.

If they don't uphold your complaint then your only option would be legal action, though presumably if you did have legal grounds your union would already be going down that route.

dunstonh

Whilst I sympathise with the scenario, and I am sure many will, if we cut the emotion away from the issue, you are asking Aviva to pay out for an event when the policy was no longer in force. Aviva did not change your employment or cause the policy to lapse. Yet it is they you are asking to foot the bill of tens or even hundreds of thousands of pounds.

1. Whether ombudsman will favour the insurer in this case or treat me fairly, as the FCA says? In other words, whether the word "fairness" apply to my case. I have already wasted lots of effort and don't want to deteriorate my health further if ombudsman is going to reject again.

Fairness doesn't mean that the company should pay out if you are not covered. Fairness means they should listen to your complaint to see if it has merit and then respond without prejudice or take any negative action against you.

At the end of the day, no third party with limited info can second guess what the FOS will do. We have so little info but the FOS will have a lot more. So, you will need to follow it through. However, generally, you would expect the FOS to apply the in-force dates as that is a key thing with insurance. They may look at the diagnosis dates.