Zurich Retail Protection Stalling on Critical Illness / TPD Claim – Anyone Else Experienced This?

electricdemon

Hi everyone,

I am looking for some insight or shared experiences from anyone who has battled Zurich Retail Protection over a Critical Illness / Severe Functional Impairment claim (filed on the 30th April 20206).

My situation involves a severe, chronic cardiac condition resulting from a historical heart attack. The medical evidence is absolute: objective, gold-standard hospital testing logs my respiratory and cardiac metrics (VO2 max) well within the severe impairment threshold required by the policy criteria. The condition has been documented in my NHS records as active and chronic for over two years.

Despite having all the necessary clinical data on their desk, Zurich's claims team has subjected me to a continuous loop of administrative delays:

• Constantly failing to provide promised updates, requiring me to chase every time.
• Shifting timelines from "calendar days" to "working days" to buy themselves more time.
• Claiming the file is perpetually "under specialist review" or awaiting sign-off.

I have officially hit my limit and logged a formal operational and service complaint last week, which has started the regulatory 8-week clock before I can escalate to the Financial Ombudsman Service (FOS).

Has anyone else experienced this specific pattern of stalling with Zurich? Did logging a formal complaint force them to resolve it internally, or did you have to go all the way to the Ombudsman to get a payout? Any tips on keeping the pressure on their complaints team would be greatly appreciated.

Thanks in advance.

dunstonh

I am looking for some insight or shared experiences from anyone who has battled Zurich Retail Protection over a Critical Illness / Severe Functional Impairment claim (filed on the 30th April 20206).

Thanks for providing the date. It indicates that it was not that long ago.

Has anyone else experienced this specific pattern of stalling with Zurich? 

We don't know what the pattern is. All we know is when you put the claim in. What happens after that is the insurer will be contacting the GP. In the vast majority of cases, that is where the holdup is. Especially where consultant information has yet to be updated or the GP needs to go to the consultant to obtain more information before they can reply to the insurer.

The general service line won't have access to medical data. So they will be limited on what information they can supply.

Did logging a formal complaint force them to resolve it internally, or did you have to go all the way to the Ombudsman to get a payout?

The FOS won't look to get you a payout. The FOS will just want to ascertain what the status is and the dates when things happened, and if the cause of delay is reasonable. To be fair, a claim on the 30th of April that hasn't been paid yet is not unreasonable, given the amount of back and forth that needs to go on.

Any tips on keeping the pressure on their complaints team would be greatly appreciated.

You don't want to be antagonising the complaints team. You want them on your side.

electricdemon

https://forums.moneysavingexpert.com/discussion/comment/82060285#Comment_82060285

Thank you for your reply, I appreciate it

MyRealNameToo

Just to echo Dunstonh's view, the first course of action after the initial assessment of a claim is to write to the GP asking them to complete a report. My experience of GPs (not for Zurich and for a different class of insurance) is that they charge a fortune for the report, they often dont follow the instructions, are normally very slow and when you have to send it back to them because they didnt do it right the first time there is often then a debate about them charging a second fee.

For example, we would typically send a 3 page report request… yes thats 6 sides but its questions and answers like how long as the claimant been registered at your practice so no way near as long or as complex as it sounds. In one case they initially responded with an invoice for £350 + VAT and noted the report would not be looked at until the fees had been paid.

So paid it, after much chasing and about 3 months after the original report was requested we got it back, totally blank, unsigned but stapled to it a photocopy of someone's complete medical file. Totally inappropriate, I had no need to know about their ED and other issues, plus I needed them to give a medical opinion on the claim they were previously fine and now had whiplash.

So went back to them again and pointed out we need the form completed not their medical history (other than as requested on the form) and a month later got a note back saying that would require a new fee of £400+vat as the previous fee was an admin charge for photocopying which most insurers prefer.

Obviously cant guarantee its the GP, insurers do get backlogs, the problem with everyone wanting the cheapest insurance possible is no mainstream insurer has a large staff of claims people just waiting for the next claim to come in. I wouldnt be surprised if itwasnt a major contributing factor.

electricdemon

https://forums.moneysavingexpert.com/discussion/comment/82060966#Comment_82060966

Thank you for the reply also.

It was off to a rocky start to begin with, Zurich would tell me that they'd had trouble chasing medical reports when I called them for an update. I would then place the same call after that phone call and get through to the GP, or consultant and get the required info sent to Zurich.

Despite Zurich telling me I didn't need to do anything else but wait, they repeatedly failed to do the necessary to get the medical info.

Also I had never received a single update from them, it was only when I called to chase that they would tell me that they had zero success in obtaining information.

2 months later and they now just tell me 'someone will call next week', that week passes and when I call again they tell me the same that someone will call me, and they never do.

You would have thought a large insurance/organisation would have more resources to a) call/chase the medical team(s) involved in my case, and b) at least give me the courtesy to at least call/update me, even it is was to say 'we are still chasing/processing/etc', but this has never happened.

It's in the hands of their complaints dept now (I hope) although I'm yet to receive a reply to that.

My account on their website says 'pending claim' but it has never had any updates, nor documents added to my policy even acknowledging the fact I've put a complaint in.

It's almost like my case has 'slipped through' any processes/procedures at their end. I cant imagine this being the usual expected behaviour of an organisation like that for all of their claims.

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/comment/82061276#Comment_82061276

I dont know how many cases Zurich staff will be working on at a time, my claims days were Motor and I ended up defending personal injury claims (hence the pain with doctors). My case load was about 700 claims at a time, if the average calls waiting time is 15 minutes to phone a GP (or another insurer which was another big part of my job) then I can do 3 an hour and 24 a day of my 700 cases.

I personally did prefer calling these people but I know many of my peers would get the diary reminder, look into the claim, see no response had been received, and pressed a few keys to generate a new reminder letter and set the diary on for another 2 weeks.

With my employer there were no set rules on dairying, you were supposed to use your professional judgement. For this sort of thing I did 2 weeks, I know some colleagues did 3 weeks. Therefore sometimes if I am on holiday a colleague will do my diaries for me, see it was only 2 weeks since the last chaser and so simply move the diary on thinking its too soon to send another chaser.

If someone phones, it's often not one of your cases you have to look at. You generally would look at the last couple of notes and the up coming diaries and advise based on that rather than reading the whole file (and in my day half the file would still be on paper) etc. So "someone will call you next week" probably means there is a diary note to review the case next week and the operator is assuming/hoping that will result in communications but diaries arent always actioned on time and sometimes the action is just to send a chaser letter and diary on.

GPs are also typically more concerned about the views of their patients than those of insurers, so personally would suggest to claimants it may be worth their while giving them a chaser

Weighty1

Just to confirm, the is claim on the TPD element of the plan or for one of the specific critical illnesses, such as heart failure?

If it's the former then the problem can sometimes be getting a doctor to confirm that your condition totally and permanently prevents you from doing your own occupation/suited occupation/certain daily tasks (delete as applicable).

Doctors are often hesitant to resign something as being permanent as they don't know how you'll respond to certain treatments, medical advances, miracles cases etc.

As Dunstonh said, a claim starting at the end of April still isn't particularly dragging on and especially so if medical evidence has been slow in being returned.

As a broker myself, I would also love there to be more case handlers, underwriters, administrators, however, the market is such that price is often see as king and would you have proceeded with Zurich if they were more expensive than other companies because they've got a much larger workforce? I know that most people wouldn't.

electricdemon

Thank you for all of you insights/help. It is very much appreciated

electricdemon

Just missed a call from them, I called back.. They have decided to settle the claim in full. 😁

Finally can get some financial security after a huge uphill struggle. Both health-wise and the stress from this process.

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/comment/82076277#Comment_82076277

Glad you got it sorted and the outcome you hopped for.