Critical Illness claim..

warspite

Hello all.

My wife and I have had critical illness cover for the past 6 years costing us more than £100 monthly. My wife was diagnosed with Breast cancer in Nov' 07 and as it is a listed critical illness we submitted our claim.

The claim is still ongoing as the insurance company have a couple of issues with my wife's medical history & want clarification on a couple of matters.

She suffers with back ache but has never been diagnosed with any condition. Her policy states that she has never suffered from or been treated for back pain.

About 10 years ago she was admitted to hospital with unexplained stomach pains which her medical record shows that these could have been caused by a kidney infection although this was never proven. Her policy states that she has never suffered from or been treated for kidney related problems.

The insurance company are waiting on clarification from our GP on these two matters.

I don't understand why they want this clarification as they are in no way related to the development of breast cancer.

I am currently off work to care for my wife and family and not being paid. I have little money saved as salary pays my bills and mortgage. I am going to start to struggle to pay my mortgage being unpaid.

The insurance company are quick enough to take my money every month but now I need them to settle my claim they are certianly doing their best not to!

Can they refuse to pay out due to non-disclosure of non-treated and non-related ailments which to be fair could have been an oversight due to the way they word there application form??

Comments appreciated.

dunstonh

I don't understand why they want this clarification as they are in no way related to the development of breast cancer.

If its due to non-disclosure then the insurance company will want to make sure of it. Plus, if the claim is successful, they may wish to reduce it by the amount of extra premiums that should have been paid if the medical history is one that would have resulted in higher premiums.

The insurance company are quick enough to take my money every month but now I need them to settle my claim they are certianly doing their best not to!

You cannot blame them. In simple terms, a fraudulent application was made and they are treating it as such. Plus, they want to make sure your wife was paying the right premium.

Can they refuse to pay out due to non-disclosure of non-treated and non-related ailments which to be fair could have been an oversight due to the way they word there application form??

There is a clear defined standard with non disclosure which is set out by the FOS. If its inadvertent non-disclosure and there is no link with the conditions then it should be paid out. Although there may be an amount held back to cover premium difference. If its shown that it wasnt inadvertant non-disclosure then they can refuse the claim.

The FOS have a factsheet on this:
http://www.financial-ombudsman.org.uk/publications/factsheets/medical_nondisclosure.pdf

warspite

Thankyou for your reply .. the link was most helpful.

However I would just like to say that we have in no way made a fraudulent application and the insurance company have no right in treating us like criminals.

Perhaps our IFA misinterpreted some of the questions posed by the insurance company but we have in no way knowingly not declared any condition.

I will give you an example;

My wife suffers from back ache for which her GP has prescribed pain killers

Q) Have you at any time had or been advised to have any medical investigation or consultation, advice, operation or treatment for any of the following categories of medical conditions in sections 2a, 2b, and 2c?

2b) 5) Arthritis, rheumatism or any form of neck, back or spinal trouble?

A) No/Not applicable

Answered "No" due to the following text contained in "Important help notes about specific information that need or need not be disclosed":

"For all cases without cic, waiver or mpi you can ignore the following: back ache, back spasm, cricked neck, disc prolapse, or any operation to correct this"

How would anybody else have answered this question?

Why are the insurance company now investigating further? And I still don't understand the connection bewteen back ache and our claim for breast cancer..

If I haven't got enough stress already without this. My wife is obviously not working or earning at the moment. I am on unpaid leave to care for her and my two children aged 4 and 5. I still have a mortgage to pay and people try to make out I am a criminal. IT ISN'T FAIR!

dunstonh

How would anybody else have answered this question?

Your wife suffers from backache and that question is where you should have answered it. The notes say you shouldnt ignore it for cic.

Why are the insurance company now investigating further? And I still don't understand the connection bewteen back ache and our claim for breast cancer..

They are checking to see if they would have offered cover in the first place or would have offered it on revised terms (typically higher premiums). If they would have offered cover but say at £5pm more then they will deduct from the claim the equivalent of £5pm more for the period up until the claim.

warspite

thanks again for your reply, it is appreciated.

i guess my ifa misinterpreted the help notes and presumed having bach ache wasn't an issue. therefore if the insurance co. do not pay up for our breat cancer claim i will hold him responsible as he was acting on our behalf.

my critical insurance cover costs me over 100 pounds a month and i have been paying this policy fOR more than 7 years. i feel Robbed!

dunstonh

i guess my ifa misinterpreted the help notes and presumed having bach ache wasn't an issue. therefore if the insurance co. do not pay up for our breat cancer claim i will hold him responsible as he was acting on our behalf.

That is a careless error or an inexperienced error. Any experienced adviser could almost tell you to the word what questions are going to be asked and what questions are only applicable to CI or Income related insurances. It is virtually universal that questions like that apply to CI and Income protection and not life assurance.

You could have a case against the adviser.

my critical insurance cover costs me over 100 pounds a month and i have been paying this policy fOR more than 7 years. i feel Robbed!

You wont be saying that when they pay out. They almost certainly will pay out as the condition isnt linked.

lah

Just A Quick Question Is The Insurance Company Norwich Union By Any Chance.if So They Are Know For Not Paying Out My Sister Has Small Cell Lung Cancer And Three Months To Live And She Didnt Know This When She Went N Holiday And Was Taken Ill But She Claimed And Was Told She Had A Pre Illness And Wasnt Covered It Cost Us Loads To Pay Hospital Bills And Get Her Home Hope You Win