Financial Ombudsman and LV

liveletlive

My daughter was diagnosed with leukaemia, this had a profound effect on my mental health and I tired claim on the income protection as I wasn't fit to work. LV insurance declined my insurance as 30 days before a 2 year standard mental health exclusion was to expire I asked for a ADHD assessment because I was curious after doing an online assessment (non medical).

I asked for an ADHD assessment in March 2023 and my exclusion would have expired in April 2023. I didn't expect that asking for a an assessment will invalidate my insurance.

My own health deteriorated in October secondary to being told my 5 year old daughter had low chances of survival.

LV declined my claim and then suggested I contact mind the mental health charity for support as they work with them. I contacted Mind legal and they were surprised LV were declining my claim for simply asking for an assessment without a diagnosis and then they advised me that ADHD Is not a mental disorder this is on their website as well) and my 2 year exclusion in the policy was for a mental disorders only.

I acquired letters from an NHS Psychiatrist and a NHS ADHD specialist both doctors and sent it to LV they still declined and claimed their in house doctors disagree.

I raised this will the ombudsman and its feels like they haven't understood the case properly but they are blindly supporting LV here is a quote from the Ombudsman investigator:

FOS Investigator: When something isn't defined in an insurance contract, we consider the fairest way for the insurer to interpret terms. This is often based the common understanding or dictionary definition.

Insured : Why is FOS taking the complete opposing view of basic contract law which states that ambiguity should be settled in favour of the party who did not draft the contract? Where in the dictionary does it state that ADHD is a mental disorder?

When I challenged this they retracted it.

They are saying that the two NHS letters are not stating that ADHD is not a mental health disorder but here are two lines pasted from the letters.

Insured: The two attached documents state that ADHD is a neurodevelopmental disorder not a mental disorder specifically, at best I had neurodevelopmental disorder symptoms NOT mental disorder symptoms
FOS Investigator: Numerous medical organisations, including the World Health Organisation (WHO) and the American Psychiatric Association (in DSM-5) list neurodevelopmental disorders (such as ADHD) as a type or subset of mental disorders. So saying that ADHD is a neurodevelopmental disorder, doesn't mean that it is not a mental disorder. Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder. And as such I don't think they change the outcome of the complaint.
Insured: to quote you "Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder" (as above) here are the extracts copied and pasted directly from the NHS doctors letters:
"to my experience and knowledge ADHD is often categorised as a neurodevelopmental disorder,' not a specific 'mental disorder" (NHS letter from Dr x)"I would also like to highlight that ADHD is not a mental health disorder but rather is a neurodevelopmental disorder" (NHS letter from x)The FOS and LV understanding are identical on this matter and many others, however Dr  the most qualified person to provide a written letter of his opinion is far more qualified to interpret this and if you look at the fourth paragraph of his letter he quotes the same material as FOS and LV but interpest them completely differently. Why are medical professionals' interpretations being dismissed in favour of nonmedical opinions?Please also don't forget Mind the mental health charity recommended by LV will clarify this if you call their legal line.Please also note the ADHD doctor has confirmed that discrimination is plausible and he will explore this with me when my assessment is due, This will include FOS.
I've come to realise that LV insurance has many solicitors on its executive board and I feel that the Financial Ombudsman Service is afraid of them.

Legal firms will only offer no win no fee if the success chance is more than 90%, to fund it myself is too high risk as I have no income, coming in. Both me and my wife are taking care of our child.

I have contacted many pro-bono services and everyone is too busy.

Someone must have had similar experiences, when I raised a complaint to the ombudsman manager they don't even address the questions I ask. they simply dismiss everything and tell me they can't do anything.

The ombudsman report has errors and quotes me as having said things I didn't say, when I asked for clarification they say its the ombudsmans understanding. When I ask them to update the report to state I did not say this they state its not relevant but then reference this point to make their final decision.

I'm worn down, I need to focus on my daughter, but I feel this is what they want. 

what do I do next? someone must be able to give me some helpful advice?

Voyager2002

I suggest a meeting with your MP (once you have one again after the election). Highlight that the FOS ruling seems to be wrong in law and contradicts medical advice on ADHD. And of course the fact that asking for an assessment is very different from falling ill. Ask your MP to contact someone senior within the FOS.

dunstonh

I've come to realise that LV insurance has many solicitors on its executive board and I feel that the Financial Ombudsman Service is afraid of them.

The FOS has nothing to be afraid of.  

is this your case: https://www.financial-ombudsman.org.uk/decision/DRN-4692283.pdf

The FOS report here says that the ADHD assessment was requested after symptoms had been reported.  This is important as it's not the diagnosis that matters but the symptoms.  And no insurer will offer cover in a new area of coverage where there are symptoms but no diagnosis.   

Based on the information in the FOS publication, I  am afraid, I cannot see anything wrong with their response.   

in particular, taking your post above, you miss some key bits of information.

I asked for an ADHD assessment in March 2023 and my exclusion would have expired in April 2023. I didn't expect that asking for a an assessment will invalidate my insurance.

You asked for an assessment as you had symptoms.  It's all about symptoms.  Not diagnosis.   The black and white facts are that you had symptoms before the qualifying date.

It is also relevant that the exclusion existed in the first place as you had previous symptoms. 

Insured: The two attached documents state that ADHD is a neurodevelopmental disorder not a mental disorder specifically, at best I had neurodevelopmental disorder symptoms NOT mental disorder symptoms

The definition of ADHD is largely irrelevant as the insurer considers it related to mental health, either directly or indirectly.    And MIND, along with many others, say, "We know that if you have ADHD, you’re more likely to experience a mental health problem."

So, LV has a justified reason for not offering mental health coverage.  Especially, as you already had mental health issues at or just before the time of application.

Its a bit like pins and needles doesn't mean you have had a stroke.  However, if you have been suffering pins and needles persistently enough for an assessment, then its likely that an an insurer would not offer cover for a stroke.  its an issue that indicates a higher risk towards another issue.

Someone must have had similar experiences, when I raised a complaint to the ombudsman manager they don't even address the questions I ask. they simply dismiss everything and tell me they can't do anything.

Some of what you put in the ombudsman report is irrelevant or unnecessary to cover as it has no bearing on the outcome of the complaint.    Sometimes, these are referred to as a scattergun approach where you try to list as much as possible, but in reality, the bulk of what you list is not pertinent to the outcome.  The outcome addresses the pertinent points.

I'm worn down, I need to focus on my daughter, but I feel this is what they want. 
what do I do next? someone must be able to give me some helpful advice?

as it stands, I am struggling to see any wrongdoing in LVs decision. Much the same as the FOS outcome.  it is in line with what would be expected with medical conditions.   Some of this appears to stem from the fact you reference diagnosis of mental health but that doesn't matter.  Its the symptoms that matter and they occurred before the date.

Sorry.

dunstonh

Voyager2002 said:

I suggest a meeting with your MP (once you have one again after the election). Highlight that the FOS ruling seems to be wrong in law and contradicts medical advice on ADHD. And of course the fact that asking for an assessment is very different from falling ill. Ask your MP to contact someone senior within the FOS.

Reading the FOS report and noting that an increased likelihood of mental health issues does exist with ADHD coupled with the fact the OP already had mental health issues prior to application for the policy does not suggest any wrongdoing or incorrect interpretations.

https://www.mind.org.uk/information-support/tips-for-everyday-living/adhd-and-mental-health/

We know that if you have ADHD you’re more likely to experience a mental health problem. There’s evidence that anxiety, depression, conduct disorder (persistent patterns of antisocial, aggressive or defiant behaviour), substance abuse, and sleep problems are all more common with people who have ADHD.

---
It doesn't mean you are going to suffer but it means you are at higher risk of suffering and insurers will either increase price to cover the increased risk or they will exclude the cover.     In this case, the OP was refused the removal of the existing exclusion.

liveletlive

@dunstonh thank for looking at this and taking interest, please appreciate that I 100% understand that any advice I get here is worthless from you an others if I am not completely honest on the thread, you must understand you are referencing "the report" I am complaining about to validate the very same report.

I'll try to clarify some of your points below to try and earn your trust:

is this your case: (Im note allowed to post links Link should be here>)

Yes this is the first report, the case has been reopened since after I got the two NHS doctors letters as stated above letters.

The FOS report here says that the ADHD assessment was requested after symptoms had been reported.  This is important as it's not the diagnosis that matters but the symptoms.  And no insurer will offer cover in a new area of coverage where there are symptoms but no diagnosis. 

I didn't leave out the details, I have never reported that I had symtoms FOS (ombudsman) even acknowledged this in an email but refuse to change it in their report, this is what I am talking about here:

The FOS report here says that the ADHD assessment was requested after symptoms had been reported.  This is important as it's not the diagnosis that matters but the symptoms.  And no insurer will offer cover in a new area of coverage where there are symptoms but no diagnosis.  

Please be assured I am not hiding any information, I want the support here to be useful to me.

Since the first ombudsman report being produced two NHS doctors a Psychiatrist and and ADHD assessor have both wrote to LV as quoted in my orignal post:

Insured: The two attached documents state that ADHD is a neurodevelopmental disorder not a mental disorder specifically, at best I had neurodevelopmental disorder symptoms NOT mental disorder symptoms
FOS Investigator: Numerous medical organisations, including the World Health Organisation (WHO) and the American Psychiatric Association (in DSM-5) list neurodevelopmental disorders (such as ADHD) as a type or subset of mental disorders. So saying that ADHD is a neurodevelopmental disorder, doesn't mean that it is not a mental disorder. Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder. And as such I don't think they change the outcome of the complaint.
Insured: to quote you "Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder" (as above) here are the extracts copied and pasted directly from the NHS doctors letters:

"to my experience and knowledge ADHD is often categorised as a neurodevelopmental disorder,' not a specific 'mental disorder" (NHS letter from Dr x)"

"I would also like to highlight that ADHD is not a mental health disorder but rather is a neurodevelopmental disorder" (NHS letter from x)

The FOS and LV understanding are identical on this matter and many others, however Dr  the most qualified person to provide a written letter of his opinion is far more qualified to interpret this and if you look at the fourth paragraph of his letter he quotes the same material as FOS and LV but interpest them completely differently. Why are medical professionals' interpretations being dismissed in favour of non-medical opinions?

Please also don't forget Mind the mental health charity recommended by LV will clarify this if you call their legal line.Please also note the ADHD doctor has confirmed that discrimination is plausible and he will explore this with me when my assessment is due, This will include FOS.

I've come to realise that LV insurance has many solicitors on its executive board and I feel that the Financial Ombudsman Service is afraid of them.

(Quote from above taken from an email between me and FOS)

The GP's notes clearly state that I was promoted by an online assessment, I have never reported I had symptoms and the Ombudsman since producing the report have acknowledged this but refuse to change the wording. They state its immaterial. However as you have identified above its all about the symptoms at the time of producing the first report:

Here is an email extract with the ombudsman data controller:

Insured (me): They quote me as having said that I "entered symptoms into an online non medical assessment tool" they then refer to this incorrect claim and base decisions on further on in the ombudsman report.”
FOS Data controller: I established this was related to the final decision which was issued by the Ombudsman Manager, SH. I’ve liaised with SH and had a review of the wording myself. The decision confirms that SH summarised your comments rather than quoting what you specifically said. In my view, when you took the assessment, you answered questions about your symptoms – which is akin to entering symptoms into an online tool.

The ombudsman can clearly says I reported this when this is actually their own conclusion, and you absolutely don't enter symptoms into an online non-medical assessment otherwise it has no value. I'm interested in your thoughts now you know this.

Its a bit like pins and needles doesn't mean you have had a stroke.  However, if you have been suffering pins and needles persistently enough for an assessment, then its likely that an an insurer would not offer cover for a stroke.  its an issue that indicates a higher risk towards another issue.

The above is a very interesting point and exactly what I thought. However I did some critical research and founds two critical points:

1. Contra Proferentem rule where ambiguity in a contract should always favour the party that did not draft the contract. (this is standard practice, thats why if I get a letting contract wrong I won't be able to evict a tenant easily) ”. Case is Houghton v Trafalgar Insurance Co Ltd [1954] 1 QB 247, where an ambiguity in an insurance policy was interpreted against the insurer
2. The vast amount of insurance case law that states rules cannot be too broad. ie a headache is a symptom of mental disorder.  Case law, such as Ailsa Craig Fishing Co Ltd v Malvern Fishing Co Ltd [1983] 1 WLR 964, establishes that insurance exclusions should be interpreted narrowly. 

(There is loads of case law to support this, I am out of my comfort zone here)

Reading the FOS report and noting that an increased likelihood of mental health issues does exist with ADHD coupled with the fact the OP already had mental health issues prior to application for the policy does not suggest any wrongdoing or incorrect interpretations.

I did not have any mental health issues prior to my daughter falling sick, I have provided a GP's note to this effect to all parties:

From your records you have no diagnoses relating to mental health that why I am a little confused.

(extract from an email from my GP)

In relation to you referencing the mind website, am I wrong to think that if this is a risk for the insurer then they need to write this into their contract. They can't retrospectively make correlation. I would also like to share this:

(Im note allowed to post links Link should be here, you will find the below quote on the mind website and there legal team will say the same)

Attention deficit hyperactivity disorder (ADHD). ADHD is not a learning disability, and it is not a mental health problem.  (Mind website)

To briefly summarise:

• I never reported I had symptoms (extract from email provided above)
• I have two doctors letters which states ADHD is not a mental disorder (recently provided to FOS)
• I have confirmation from my GP that I had no mental health issues prior to my daughters sickness
• Its common legal practice for ambiguity in a contract should always favour the party that did not draft the contract.
• The vast amount of insurance case law that states rules cannot be too broad.
  
• I appreciate there is a correlation between ADHD and mental health disorder, but this surely needs to be written into the terms of the agreement otherwise how much free reign do insurers have and where do they stop.

Any advice is welcome

liveletlive

@Voyager2002

My MP wrote to LV and they ignored the email, however I will ask them to write to FOS.

liveletlive

Im not sure if this is an unreasonable request but please take my information at face value, I understand to get any value out of this thread all advice must be based on truth. Otherwise I am just asking for sympathy which is not very helpful to me at all.

I really need some support here.

liveletlive

@dunstonh

Im sorry but I am unable to edit posts:

My 23:25 post the third quote box is supposed to be the following quote from my opening comment:

The ombudsman report has errors and quotes me as having said things I didn't say, when I asked for clarification they say its the ombudsmans understanding. When I ask them to update the report to state I did not say this they state its not relevant but then reference this point to make their final decision.

DullGreyGuy

liveletlive said:

@dunstonh thank for looking at this and taking interest, please appreciate that I 100% understand that any advice I get here is worthless from you an others if I am not completely honest on the thread, you must understand you are referencing "the report" I am complaining about to validate the very same report.

I'll try to clarify some of your points below to try and earn your trust:

is this your case: (Im note allowed to post links Link should be here>)

Yes this is the first report, the case has been reopened since after I got the two NHS doctors letters as stated above letters.

The FOS report here says that the ADHD assessment was requested after symptoms had been reported.  This is important as it's not the diagnosis that matters but the symptoms.  And no insurer will offer cover in a new area of coverage where there are symptoms but no diagnosis. 

I didn't leave out the details, I have never reported that I had symtoms FOS (ombudsman) even acknowledged this in an email but refuse to change it in their report, this is what I am talking about here:

The FOS report here says that the ADHD assessment was requested after symptoms had been reported.  This is important as it's not the diagnosis that matters but the symptoms.  And no insurer will offer cover in a new area of coverage where there are symptoms but no diagnosis.  

Please be assured I am not hiding any information, I want the support here to be useful to me.

Since the first ombudsman report being produced two NHS doctors a Psychiatrist and and ADHD assessor have both wrote to LV as quoted in my orignal post:

Insured: The two attached documents state that ADHD is a neurodevelopmental disorder not a mental disorder specifically, at best I had neurodevelopmental disorder symptoms NOT mental disorder symptoms
FOS Investigator: Numerous medical organisations, including the World Health Organisation (WHO) and the American Psychiatric Association (in DSM-5) list neurodevelopmental disorders (such as ADHD) as a type or subset of mental disorders. So saying that ADHD is a neurodevelopmental disorder, doesn't mean that it is not a mental disorder. Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder. And as such I don't think they change the outcome of the complaint.
Insured: to quote you "Having looked at the NHS letters provided, neither of them say that ADHD is not a mental disorder" (as above) here are the extracts copied and pasted directly from the NHS doctors letters:

"to my experience and knowledge ADHD is often categorised as a neurodevelopmental disorder,' not a specific 'mental disorder" (NHS letter from Dr x)"

"I would also like to highlight that ADHD is not a mental health disorder but rather is a neurodevelopmental disorder" (NHS letter from x)

The FOS and LV understanding are identical on this matter and many others, however Dr  the most qualified person to provide a written letter of his opinion is far more qualified to interpret this and if you look at the fourth paragraph of his letter he quotes the same material as FOS and LV but interpest them completely differently. Why are medical professionals' interpretations being dismissed in favour of non-medical opinions?

Please also don't forget Mind the mental health charity recommended by LV will clarify this if you call their legal line.Please also note the ADHD doctor has confirmed that discrimination is plausible and he will explore this with me when my assessment is due, This will include FOS.

I've come to realise that LV insurance has many solicitors on its executive board and I feel that the Financial Ombudsman Service is afraid of them.

(Quote from above taken from an email between me and FOS)

The GP's notes clearly state that I was promoted by an online assessment, I have never reported I had symptoms and the Ombudsman since producing the report have acknowledged this but refuse to change the wording. They state its immaterial. However as you have identified above its all about the symptoms at the time of producing the first report:

Here is an email extract with the ombudsman data controller:

Insured (me): They quote me as having said that I "entered symptoms into an online non medical assessment tool" they then refer to this incorrect claim and base decisions on further on in the ombudsman report.”
FOS Data controller: I established this was related to the final decision which was issued by the Ombudsman Manager, SH. I’ve liaised with SH and had a review of the wording myself. The decision confirms that SH summarised your comments rather than quoting what you specifically said. In my view, when you took the assessment, you answered questions about your symptoms – which is akin to entering symptoms into an online tool.

The ombudsman can clearly says I reported this when this is actually their own conclusion, and you absolutely don't enter symptoms into an online non-medical assessment otherwise it has no value. I'm interested in your thoughts now you know this.

Its a bit like pins and needles doesn't mean you have had a stroke.  However, if you have been suffering pins and needles persistently enough for an assessment, then its likely that an an insurer would not offer cover for a stroke.  its an issue that indicates a higher risk towards another issue.

The above is a very interesting point and exactly what I thought. However I did some critical research and founds two critical points:

1. Contra Proferentem rule where ambiguity in a contract should always favour the party that did not draft the contract. (this is standard practice, thats why if I get a letting contract wrong I won't be able to evict a tenant easily) ”. Case is Houghton v Trafalgar Insurance Co Ltd [1954] 1 QB 247, where an ambiguity in an insurance policy was interpreted against the insurer
2. The vast amount of insurance case law that states rules cannot be too broad. ie a headache is a symptom of mental disorder.  Case law, such as Ailsa Craig Fishing Co Ltd v Malvern Fishing Co Ltd [1983] 1 WLR 964, establishes that insurance exclusions should be interpreted narrowly. 

(There is loads of case law to support this, I am out of my comfort zone here)

Reading the FOS report and noting that an increased likelihood of mental health issues does exist with ADHD coupled with the fact the OP already had mental health issues prior to application for the policy does not suggest any wrongdoing or incorrect interpretations.

I did not have any mental health issues prior to my daughter falling sick, I have provided a GP's note to this effect to all parties:

From your records you have no diagnoses relating to mental health that why I am a little confused.

(extract from an email from my GP)

In relation to you referencing the mind website, am I wrong to think that if this is a risk for the insurer then they need to write this into their contract. They can't retrospectively make correlation. I would also like to share this:

(Im note allowed to post links Link should be here, you will find the below quote on the mind website and there legal team will say the same)

Attention deficit hyperactivity disorder (ADHD). ADHD is not a learning disability, and it is not a mental health problem.  (Mind website)

To briefly summarise:

• I never reported I had symptoms (extract from email provided above)
• I have two doctors letters which states ADHD is not a mental disorder (recently provided to FOS)
• I have confirmation from my GP that I had no mental health issues prior to my daughters sickness
• Its common legal practice for ambiguity in a contract should always favour the party that did not draft the contract.
• The vast amount of insurance case law that states rules cannot be too broad.
  
• I appreciate there is a correlation between ADHD and mental health disorder, but this surely needs to be written into the terms of the agreement otherwise how much free reign do insurers have and where do they stop.

Any advice is welcome

Appreciate this is a highly sensitive matter for you but as an outsider with no vested interest in the outcome I strongly disagree in your statement that you didnt report "symptoms" as clearly any "online assessment" is going to ask about symptoms and assuming the assessment has any credibility at all then you must have given answer that indicated you do have symptoms that could indicate the condition. 

In a similar vein I would be shocked if you spoke to a GP saying only that you did an online test out of random curiosity never thinking it may be something you have and the GP asked not a single question about symptoms but instead did a fairly expensive referral blindly. 

Ultimately if you disagreed with the mental health condition exclusion the time to challenge it was before purchasing it. Arguing after agreeing to the exclusion that the exclusion shouldn't have been added to the policy is almost certainly going to fail. Why didnt you argue it before buying? If you wanted mental health cover why didnt you get quotes elsewhere if LV wouldn't remove it? 

liveletlive said:
Legal firms will only offer no win no fee if the success chance is more than 90%, to fund it myself is too high risk as I have no income, coming in. Both me and my wife are taking care of our child.

ATE insurance/Conditional Funding Arrangements (aka no win, no fee) require a 51% chance of success not 90% however courts very rarely side with the customer if the ombudsman have not because the courts must judge on the basis of law whereas the FOS are required to find fair outcomes which should be guided by law but isn't bound by it in the same way. 

The courts will see it very simply, you have a contract that excludes mental health claims for 2 years, you attempted to make a mental health claim in under 2 years. They won't entertain the question of if that exclusion should have been added or not as you agreeing to the contract including the exclusion overrides anything else that happened before. 


Write to who you want to but I doubt its going to do your health any good as it continues to have the same outcome and perhaps this time is better spent on your daughter than fighting a doomed battle. 

liveletlive

@DullGreyGuy

Thank you for your interest.

I can confirm that the reason for requesting the ADHD assessment was work-related, and this is documented in my GP notes. Please understand that I cannot provide specifics without revealing my identity.

I did not challenge the mental disorder exclusion initially as I did not anticipate needing it. However, it's important to note that two independent NHS doctors have stated that ADHD is not a mental disorder.

While I understand your perspective, case law and logic support my argument. I find it challenging to move forward as the FOS and others provide their opinions without justifying their positions.

As a landlord, if I fail to provide the correct documents to my tenants, I must immediately pay them three months' rent because the law favours the party who did not draft the contract. This legal principle applies to all contracts, so why should insurance companies be different?

I have lost trust in insurance companies and the FOS. Our travel insurance initially denied coverage for my daughter's sickness, our health insurance had similar issues, and our home insurance initially tried to deny our legal costs. Eventually, all these obligations were upheld, but it shouldn't be this difficult if the FOS operated correctly.

Insurance companies are out of control, purposely leaving ambiguity in their contracts. Today, I called my insurance company to inform them about installing a charge point. They told me I didn't need to notify them. When I asked if I was covered for accidental damage, seeking clarification since they hadn't sent all the documents despite multiple email requests, the representative said yes. To be thorough, I asked, "So, I am covered if I accidentally nail through a pipe or fall through the ceiling?" She replied, "No, you have accident insurance, but not DIY accident insurance." How is this clear and easy for consumers to understand? I thought I was covered for accidents while working on my house, but I wasn't. Adding DIY coverage only cost £7, but how was I to know it was needed?

For my travel insurance, I had to thoroughly review the contract myself to find the clause covering close relative sickness after being initially denied.

Regarding my daughter, of course, she means everything to me. However, without finance, it's challenging to care for her and pay the mortgage. My wife and I receive no government support as we own mortgaged property intended for our retirement, and we are depleting our retirement funds. We are 40% and 60% taxpayers when we are able to work and have never received any government aid. My daughter receives DLA, which barely covers our council tax. We refuse to rely on charity, so I will have to return to work despite not being in the right headspace.

A hospital nurse told me 4 people a year at most get the type of leukaemia and our hospital is one in four places in the world that treats it. My sickness is secondary to hers, if she didn't fall sick I would have never claimed. Whats has ADHD got to do with it!?!?

DullGreyGuy

liveletlive said:

I can confirm that the reason for requesting the ADHD assessment was work-related, and this is documented in my GP notes. Please understand that I cannot provide specifics without revealing my identity.

Specifics nor your identity is required, the point is there were "reasons" (aka symptoms) that ultimately convinced the GP to order investigation.

liveletlive said:
I did not challenge the mental disorder exclusion initially as I did not anticipate needing it. However, it's important to note that two independent NHS doctors have stated that ADHD is not a mental disorder.

If ADHD is or isn't a mental health condition is irrelevant, based on whatever reason they offered you cover excluding mental health cover and you decided to accept that. When I bought my private medical insurance I was offered it with or without mental health cover with a difference of £75 in premiums. 

I never thought we'd require MH cover but ultimately thought that for the price it was worth paying and a £30,000 claim later that proved to be a wise decision. 

Insurance claims are littered with complaints from people who choose not to take optional extras or accept a budget policy and come to regret it afterwards. Ultimately you accepted a policy with a limitation rather than shopping around etc and that decision has come to bite just like the person who buys TPFT insurance and then his involved in a hit and run. 

I could bring to market tomorrow a new form of health related insurance that covers everything other than loss of your pinky finger on your non-dominate hand. There doesn't need to be logic to why I want to exclude that peril as long as the contract wording is clear and its called out in the IDD as an unorthodox policy limitation. The FOS nor the courts would ever uphold a claim that it was unfair that this exclusion existed. 

liveletlive said:

While I understand your perspective, case law and logic support my argument. 

Unfortunately you are the only one seeing it that way, the fact the insurer, ombudsman, the solicitors you've approached and all those that work in insurance on here see the opposite is telling, particularly the no win no fee solicitors that will have access to said case law and are financially incentivised to see your point of view.

liveletlive said:

For my travel insurance, I had to thoroughly review the contract myself to find the clause covering close relative sickness after being initially denied.

As everyone should, though before buying rather than at point of claim. Thats why the majority of claims that are declined are on big things that are fundamentally not covered rather than small technicalities. 

liveletlive said:
We are 40% and 60% taxpayers when we are able to work 

Given the top rate of income tax is 45% (48% Scotland) thats probably something else you want to look into

liveletlive said:

(Sorry for the GPT prompt, I really need edit permissions)

Suspect your fairly close to the post count requirement to be able to