Payout

shanky1234

Hi I'm looking for some advice. My husband was recently in an accident where he broke his neck in 2 places. He has been left with some long term issues. He was told he will never return to his former trade of employment as a joiner. We found in our life/critical illness cover a section which stated if you can no longer work in your former trade/occupation we would be entitled to the pay out of the sum assured. The insurance company are now saying we have maybe been sent incorrect policy documents and that he may be able to work elsewhere. I do not know where to go for help or advice. 

TELLIT01

I think you are going to need to speak to a solicitor on  this.  If the insurance was taken out on the basis of the documents you may well have a claim against the insurers.  Anybody here can only guess what the outcome may be.

Weighty1

It sounds like you are taking about "Total & Permanent Disability".  Generally TPD is set up on 1 of 3 ways:
1. - Own occupation - this pays out if someone is totally and permanently unable to do their own job ever again.
2. - Suited occupation - this pays if someone is totally and permanently unable to do either their own job or a job to which they are suited based on training, qualifications or experience.
3. - Activities of daily work/living - this can be claimed upon if the insured person is unable to ever do (normally) 3 of 6 everyday tasks which typically including walking 200yds, climbing a flight of 12 stairs with or without using a handrail, using a telephone and taking a message, reading size 16 font and a few others.

Do you know which TPD option you policy was set up on?
Often, for more manual based occupations, you would not get option 1, although it could have been this depending on the insurer.

I will add, TPD is extremely difficult to claim upon and is one of the most contentious areas of personal insurance with an awful high number of TPD claims being declined as the disability can not be proven as being permanent or does not satisfy the "totally" part enough.

[Deleted User]

You can file an official complaint. If you were sent the incorrect policy documents then you have a claim there as you would have sought a different policy that would have paid out in this situation. If you are not satisfied with their response you can escalate to the FOS or get a lawyer.