critical illness claim

Jeankirk

my husband was diagnosed with a NET lung cancer in May 23 and has since had surgery to remove part of his lung.  We had critical illness cover taken out as advised by our mortgage broker in 2016 as he would only receive ssp if he was off work if this situation happened.  We made the claim in May and the insurance company has still not come to a decision nearly 6 months later. Fortunately I am working but trying to pay a mortgage and cost of living etc just on my wage is a struggle so just want a decision as we have to continue to pay the large premium on this until its resolved.  They have said they need yet more information from the gp on his smoking status a year before we took out the policy and some more information on his mental health.  We are so frustrated as we disclosed all the information we were asked at the time of taking out the policy. If they are going to reject the claim which i feel is now likely we just need to know so we can take the next steps.  Would it normally take this long to reach a decision?

jlfrs01

If the blocker to a decision is GP-supplied medical information have you asked your GP if and when this has been sent off to the Insurance Company? If your husband declared his Smoking and any treatment provided for it on the application form then there oughtn't to be an issue as they would have either refused to provide cover or increase the premiums after risk-assessment. I suspect it is this they want to check by studying his medical records. Not sure what the mental health aspect is all about unless he has received treatment for that (or reported it) and failed to declare that in the application. In any event, carry on paying the premiums but all roads lead back to the GP to find out if and when your husband's medical records were provided and if not, why not. There may be a charge but the Insurers usually pick up the tab for that.

dunstonh

They have said they need yet more information from the gp on his smoking status a year before we took out the policy and some more information on his mental health.  We are so frustrated as we disclosed all the information we were asked at the time of taking out the policy.

If you disclosed everything correctly at the outset then there is nothing to fear.

. If they are going to reject the claim which i feel is now likely we just need to know so we can take the next steps.  Would it normally take this long to reach a decision?

Insurance companies, despite their reputation, are not that slow most of the time.    You usually find the blockage is the supply of information coming from your surgery.   Either insufficient information or cryptic information or something the GP has said that leads them to question the original application.  i.e. if the GP has said that it was lung cancer as a result of smoking then someone declaring non-smoker at the application would see the insurer, logically, obtain new information. (example only, not saying that is the case here)

DullGreyGuy

The insurers are saying they're waiting for something from the GP... so have you chased your GP? 

My experience of GPs and claims (not CI) is they are slow, money grabbing and verging on incompetent/reckless. The last ever claim I personally handled the GP firstly didn't answer the questionnaire but sent a photocopy of all the records. When resending the questionnaire they wanted a second fee. Got a partially completed form and even a cursory look showed it was inconsistent with the records and they wanted a third fee to correct and finish completing it. The form asked for facts and expert judgement.