Equity & Law Multiplan Lifecare critical illness claim - AVIVA LOST FILES HENCE REFUSING CLAIM

SETHASHER66

AVIVA REFUSING CRITICAL ILLNESS CLAIM DUE TO AVIVA DISCARDING OLD AXA SUN LIFE EQUITY & LAW POLICY RECORDS IN THEIR ROMFORD OFFICE ! PLEASE HELP
 
I Desperately need help please with an old AXA Equity & Law MULTIPLAN LIFECARE critical insurance policy please effected in 1990. 

I would be much obliged if you have retained old insurance papers confirming the critical illness conditions added to the LIFECARE element of the MULTIPLAN  i.e. the critical illness policy circa 1999 through to 2002 

Background: The policy is now owned by AVIVA - I am making a claim for heart Surgery but AVIVA are rejecting my claim stating that my condition is not covered under the policy. AVIVA are incorrectly saying that only 6 illness conditions are covered and that no further additional critical illness were added. I know for a fact this is not correct bc i have a copy of an appendix that confirms a further 12 illness conditions had been added from 1990 to 1998. My heart condition is not on the list but many more illness conditions were added in 1999 / 2000.

FRIENDS LIFE SENT OUT A MUCH LONGER LIST OF CRITICAL ILLNESS CONDITIONS IN 2014.  

AVIVA ARE WRONGFULLY REJECTING CRITICAL ILLNESS CLAIMS FOR ILLNESS CONDITIONS LISTED IN THE T&C APPENDIX BECAUSE THEY HAVE DISCARDED OLD AXA SUN LIFE ( EQUITY & LAW ) DOCUMENTS ! 

ARE YOU AFFECTED BY AVIVA’s MALADMINISTRATION ? 

I would be grateful to a forum member who held this policy and has retained a copy of key features documents listing the critical illnesses added in 1999 or 2000 or 2001 or 2002 onwards 

I have asked AVIVA for the extended list of critical illness conditions but AVIVA are refusing to disclose this information. AVIVA are asking me to provide proof that my heart conditions is covered. Yes, This is not a joke! This is the truth - this is what is actually happening in 2024 by a major life insurance company! I would be very grateful if there is a legal expert out there who knows the consumers ( legal ) rights in such a case as this. 

The Financial Ombudsman says their hands are tied in the absence of written proof of the list of critical illness conditions that pertain to my policy. 

Please can anyone help me? 

thanking you kindly in anticipation  ……

dunstonh

 i have a copy of an appendix that confirms a further 12 illness conditions had been added from 1990 to 1998. 

Normally, when conditions are added or removed, they apply to new business plans and not existing ones.

FRIENDS LIFE SENT OUT A MUCH LONGER LIST OF CRITICAL ILLNESS CONDITIONS IN 2014.  

Which again, would have applied to their current (at the time) range of products.

I would be grateful to a forum member who held this policy and has retained a copy of key features documents listing the critical illnesses added in 1999 or 2000 or 2001 or 2002 onwards 

Key features documents are unlikely to contain the medical conditions covered.  Usually its a separate document.
You need to stick to the year you bought yours.  Anything from different years wont matter.

I have asked AVIVA for the extended list of critical illness conditions but AVIVA are refusing to disclose this information. AVIVA are asking me to provide proof that my heart conditions is covered. Yes, This is not a joke! This is the truth - this is what is actually happening in 2024 by a major life insurance company! I would be very grateful if there is a legal expert out there who knows the consumers ( legal ) rights in such a case as this. 

Aviva are asking you to supply proof in case there was an error (i.e. you being told something that was wrong).  In the absence of anything supporting your allegation, then it will go with the policy term defaults at the point of sale.

DullGreyGuy

What did the covering letters of the appendixes say? 

CI is a fixed product the terms stay the same over the period of insurance including the conditions covered. Insurers however at times do change either conditions covered or the markers required for cover to keep in line with modern medicine but these only apply to new policies. Insurers will tell their existing customers that better policies now exist should an insured wish to cancel their current policy and buy a new policy with wider coverage... obviously peoples health and age change over time and so it isn't always appropriate or cost effective to. 

SETHASHER66

Hello DullGreyGuy - Thank you for your time and comments - YES, THE APPENDIX ATTACHING TO THE POLICY RULE BOOK / T&Cs CLEARLY STATES THAT THERE ARE FURTHER CIs ADDED FOR MULTIPLAN LIFECARE POLICIES EFFECTED BETWEEN TWO DATES ( END OF 1989 AND NOVEMBER 1990 ) THE COMMENCEMENT DATE OF MY POLICY FALLS BETWEEN THESE DATES HENCE CIs ARE INDEED ADDED TO MY EQUITY & LAW LIFECARE POLICY  

AVIVA HAVE ADMITTED TO HAVING LOST 20 YEARS OF INSURANCE RECORDS & FILES PERTAINING TO MY MULTIPLAN LIFECARE POLICY - THEIR ADMISSION WAS MADE IN RESPONSE TO A GDPR REQUEST FOR THE FILE. 

BECAUSE AVIVA HAVE ADMITTED LOSING THE FILES THEY ARE INCAPABLE OF MAKING A RELIABLE CLAIMS ASSESMENT IN RESPECT OF THIS PARTICULAR POLICY  - AVIVA HAVE ALSO LOST THE APPENDIX HENCE ANY POLICY HOLDER WHO MADE A CLAIM IN RESPECT OF THE CIs ADDED TO THIS POLICY WITH A COMMENCEMENT DATE BETWEEN THE AFOREMENTIONED DATES HAS HAD THEIR CLAIM WRONGFULLY REJECTED

WHEN FRIENDS LIFE WERE ASKED WHETHER MY POLICY COVERED A PARTICULAR ILLNESS CONDITION THE INSURER SENT ME A LONG LIST OF ABOUT 22 TO 26 CONDITIONS - THE HEADING ON THE A4 SHEET OF PAPER : “ EQUITY & LAW MULTIPLAN “

THIS PARTICULAR POLICY HAS CRITICAL ILLNESS CONDITIONS ADDED TO THE POLICY.

DO YOU KNOW AN IFA THAT SOLD THIS POLICY AND WHO HAS RETAINED A COMPREHENSIVE RECORD OF PAPERS ISSUED BY AXA SUN LIFE ? Or A POLICYHOLDER WHO HELD THIS POLICY AND RETAINED 30 YEARS OF HISTORIC RECORD ? 

AVIVA CLAIMS STAFF FAILED TO CORRECTLY / PROPERLY INTERPRET THE TERMS & CONDITIONS OF THE POLICY RULE BOOK DATED 19

THERE HAD BEEN A CHANGE TO MY POLICY MANY YEARS AGO PERMITTED UNDER THE VARIATION RULES - MEDICAL UNDERWRITING HAD TO BE UNDERTAKEN AND THE PREMIUM INCREASED CONSIDERABLY - THE POST SALE 14 DAY COOLING OFF DOCUMENT I HOLD CLEARLY STATES THAT AS A RESULT OF THAT VARIATION THE TERMS OF THE POLICY HAVE CHANGED AND ARE APPLIED AT THE DATE OF THE CHANGE - IT IS THE STAFF EMPLOYED BY AVIVA IN ROMFORD CONTRADICTED THE POST SALE DOCUMENT - IS PAINFULLY APPARENT AVIVA ARE EMPLOYING STAFF 

WHOM ARE NOT COMPETENT OR EXPERIENCED INSURANCE PROFESSIONALS. 

THE AVIVA CLAIMS STAFF IN ROMFORD ACTUALLY SAID THEY ASSUME  ….. I ALSO NEED TO FIND & HELP OTHER POLICYHOLDERS WHO HAVE SUFFERED THIS MALADMINISTRATION.   

BoGoF

Top tip  - stop writing in capitals if you want people to read.

SETHASHER66

Hello dunstonh - thank you for your time writing your comments - I am looking for an IFA with experience of this actual policy who had sold THE EQUITY & LAW MULTIPLAN UNIT LINKED NON QUALIFYING WHOLE OF LIFE POLICY WITH THE LIFECARE ADD ON in 1989 or 1990 - or a policy holder who retained the appendix or a policy holder who needed to make a CI claim on the policy who suffered maladministration bc AVIVA’s incompetent staff who discarded AXA SUN LIFE files and insurance records. I also need a qualified legal expert in consumer law and insurance contracts in the case of missing / lost files by staff employed by this major insurance company.

IN RESPONSE TO YOUR COMMENTS: 

1/ Normally, when conditions are added or removed, they apply to new business plans and not existing ones
NOT IN THIS CASE -  IT IS CLEARLY STATED IN WRITING THAT CIs HAVE BEEN ADDED TO THE LIFECARE PART OF THIS UNIT LINKED NON QUALIFYING WHOLE OF LIFE POLICY. THE APPENDIX ATTACHING TO THE POLICY RULE BOOK / T&Cs WAS PROVIDED BY THE IFA WHO SOLD THE POLICY - THE APPENDIX WAS PROVIDED BY AXA EQUITY & LAW - IT CLEARLY STATES THAT THERE ARE FURTHER CIs ADDED FOR MULTIPLAN LIFECARE POLICIES EFFECTED BETWEEN TWO DATES ( END OF 1989 AND NOVEMBER 1990 ) THE COMMENCEMENT DATE OF MY POLICY FALLS BETWEEN THESE DATES HENCE CIs ARE ADDED TO MY EQUITY & LAW LIFECARE POLICY. 

2/ Which again, would have applied to their current (at the time) range of products 
THIS COMMENT IS ALSO NOT CORRECT - a request had been made in regards my specific policy - the policy number had been stated - this is not a general question regarding a range of insurance products sold by the new owner  - refer to my comments above 

3/ Key features documents are unlikely to contain the medical conditions covered.  Usually its a separate document.

You need to stick to the year you bought yours.  Anything from different years wont matter. THIS IS ALSO INCORRECT - REFER TO THE FACTS STATED ABOVE. 

4/ Aviva are asking you to supply proof in case there was an error (i.e. you being told something that was wrong).  In the absence of anything supporting your allegation, then it will go with the policy term defaults at the point of sale. THIS COMMENT IS ALSO INCORRECT - THIS COMMENT IS ALSO NOT APPLICABLE IN THIS CASE - REFER TO MY COMMENTS ABOVE TO DullGreyGuy 

WHAT IS NEEDED IN THIS CASE IS AN EXPERT APPRAISED OF THE LAW AND AN EXPERIENCED PROFESSIONAL IN THE INSURANCE SECTOR WHO HAS EXPERIENCE WITH CONTENDING WITH THE FAILURES OF AN INSURANCE COMPANY TO MAINTAIN PROPER RECORDS AND WHICH HAS ADMITTED LOST / MISSING / DISCARDED FILES ( BY INCOMPETENT STAFF ) STAFF WHO ARE ALSO STRUGGLING TO CORRECTLY / PROPERLY INTERPRET THE TERMS OF THE CONTRACT even in respect of the few records they have  

retained. AVIVA CLAIMS STAFF USE THE WORD “ ASSUME “ WHEN ASSESSING A POLICY - BEWARE ! 

if there is a forum member with actual experience of this particular policy I would be obliged for your input or a Consumer law expert who has contended with a case such as this i.e. improper record keeping and incomplete insurance files and missing discarded papers ( an admission made by AVIVA in writing ) also with experience where there is evidence of misinterpretation of policy terms ( made by inept, incompetent insurance staff )