Wrong information regarding medical claim..

LibbyL92

So for the last year I’ve been going through insurance claim. As I fell ill abroad last year (USA) 

cutting a long story short I was due to receive a determination today to say wether or not the insurance are paying out.

I call up this afternoon and the insurance worker informed me that the claim is successful and they will be making full payment to the hospital. I cried with joy. They went on to explain the next steps and how it could take a few weeks to fully settle. But it was all positive and being handled. Great. Huge weight lifted. 

fast forward two hours I get a phone call from the insurance… a different person this time who informs me that the previous member of staff has given me false information and made a big mistake, that they ARE NOT paying out and my claim has fallen through. 

by this point I’m besides myself. Crushed. 

they’ve offered me £200 compensation for the mistake. 

I don’t know where to go with this. The reasons for denying the claim is because I didnt declare medication I was prescribed 18 months ago. (My sickness was not due to or related to anything to do with that medication) oversight. Ok. 

But to tell me my claim is successful and completely snatch it away from me again a few hours later…. Surely that’s a big mistake? 

I feel crushed.

Apologies if this is in the wrong place…

HillStreetBlues

I total feel for you having be told yes and then a few hours later no. You could push more more than £200  but not sure  what you could get.
What you need to find out if you can (a dummy booking can work)  is would that insurer cover you  if you had disclosed that information.
If they would have declined, then they are correct not to pay out.
But for example if you had disclosed it and they would have insured you for same price and that issue had nothing to do with with the claim  they shouldn't decline it.
Those are the two bookends  and between that is if they would have insured you but the premium would have increased.
 

TELLIT01

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

LibbyL92

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

It was sertraline for anxiety/depression. I actually never went ahead and picked the prescription up as I was put off by the side effects. 

I’ve also been reading section 11 of insurance act.
So I may have some hope.. 

user1977

LibbyL92 said:

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

It was sertraline for anxiety/depression. I actually never went ahead and picked the prescription up as I was put off by the side effects. 

But were you required to disclose the diagnosis (and if so, did you fail to do so)? Or only the medication?

LibbyL92

user1977 said:

LibbyL92 said:

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

TELLIT01 said:

Was it short term medication or something you continue to take.  If the former then refusing the claim seems a disproportional action.  If it is medication you continued to take and the underlying condition was not declared it is a different matter.

Do an internet search using "how to dispute medical insurance claim denial" and try taking it from there.

It was sertraline for anxiety/depression. I actually never went ahead and picked the prescription up as I was put off by the side effects. 

But were you required to disclose the diagnosis (and if so, did you fail to do so)? Or only the medication?

I failed to disclose both as a genuine error. 

DullGreyGuy

You unfortunately also need to read the Consumer Insurance (Disclosure and Representations) Act 2012 which may or may not give you hope.

Insurance Act S11 is about terms of the policy not being complied with... eg denying your injury claim because you forgot to use a padlock on your suitcase which is a requirement under the theft section. CIDRA is about disclosures you made when buying the policy.

Under CIDRA you have four possible scenarios:

1. You were intentional or reckless by not making the declaration about the pre-existing condition - policy void, claim avoided
2. You were careless by not mentioning it and they wouldn't have insured you had you declared it - policy cancelled, claim avoided
3. You were careless by not mentioning it and they would have insured you for an extra premium - policy stands, claim paid but proportionally reduced to reflect the under premium paid
4. You were not required to declare it (ie poor questions) - policy stands, claim paid in full

ripplyuk

OP, could you please name this company so that I can avoid them? 

LibbyL92

ripplyuk said:

OP, could you please name this company so that I can avoid them? 

Of course. 

Coverwise. (AXA)

DullGreyGuy

ripplyuk said:

OP, could you please name this company so that I can avoid them? 

No need for them to be named really... every insurer will have issues if you have failed to declare a recent medical condition that you were prescribed medicines for. 

The only exceptions are one or two policies which simply blanket exclude all pre-existing conditions and so don't ask for you to declare them but with them if you "accidentally" make a false declaration on another part of the questionnaire you will be in the same boat. 

The trick isn't to avoid certain insurers (and Axa will be one of the hardest to avoid as they are in the three insurers that dominate the sector) but make sure you are thorough when making your declarations. 

HillStreetBlues

LibbyL92 said:

ripplyuk said:

OP, could you please name this company so that I can avoid them? 

Of course. 

Coverwise. (AXA)

My friend has very bad anxiety/depression and is insured by Coverwise / AXA for a few years now, everything is fully declared.
The questions that are linked to that are once declared are:
Have you been referred to a psychiatrist for any of these conditions within the last 2 years?
Have these conditions caused you to cancel or cut short any travel plans?
How many hospital admissions have you had for these conditions in the last 2 years?
Have you had a compulsory admission to hospital as a result of these conditions?
My friend answered yes to the first one then no . zero & no My friend  also have other issues that has been fully declared. Policy was Annual and under £40

So I would be very surprised if they claim they wouldn't have insured you if you have no other health issues.