Critical Illness reject claim

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JessC
JessC Posts: 4 Newbie
in Insurance & life assurance
Hello I'm new to this forum .My husband suffered a stroke ( hemmorhage) in November and has been unwell since .His stroke has left him permanently exhausted, his personality changed and his memory muddled. The reason for not paying out ( Royal London) is because it is too soon , according to them, to know if these symptoms are permanent. They suggest we provide more evidence from his consultant neurologist if there is info to suggest permanent. This is unlikely as he has not seen the consultant due to there being no stroke clinics due to Lack of neurologists and funding at the hospital. We are gutted , he's 48 , We have a mortgage and the usual living expenses and if he remains in poor health I don't know how we will manage. Anyone experienced this before ?
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  • agrinnall
    agrinnall Posts: 23,344 Forumite
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    I'm afraid I find it hard to believe that any hospital would refuse to permit a stroke victim to be seen by a consultant neurologist. If that is really the case you need to be asking your GP for assistance in getting a referral, perhaps at a different hospital.
  • angrycrow
    angrycrow Posts: 1,078 Forumite
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    Whilst it does not help with the immediate problems look up your local headway group http://www.headway.org.uk whilst the website talks about brain injuries they include stroke related brain injury.

    Our local branch have been superb in providing support after my head injury. They also tend to run carer support groups that would enable you to get advice on coping strategies for you and your husband.

    The symptoms you mentioned are very common after head injuries/strokes after care can be very hit or miss, took me three years to get to see the correct expert so don't be afraid to keep nagging your gp. I actually had to change gp to get the correct after care.

    I find the biggest effect on my symptoms now is how much sleep I am getting and how much stress is around me. Difficult to avoid the stress in your current situation so concentrate on getting him good quality sleep.
  • sheramber
    sheramber Posts: 19,131 Forumite
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    Royal London are following the conditions of their policy.

    See page 41 of the booklet https://adviser.royallondon.com/globalassets/docs/protection/p9b0096.focus-on-our-critical-illness-definitions.pdf

    You need to pursue getting your husband seen by a consultant.

    Speak to your GP, your hospital PALS officer
    https://www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363
  • Weighty1
    Weighty1 Posts: 1,181 Forumite
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    sheramber wrote: »
    Royal London are following the conditions of their policy.

    See page 41 of the booklet https://adviser.royallondon.com/globalassets/docs/protection/p9b0096.focus-on-our-critical-illness-definitions.pdf

    You need to pursue getting your husband seen by a consultant.

    Speak to your GP, your hospital PALS officer
    https://www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

    Actually, it's page 33 which is the relevant one as page 41 relates to Total & Permanent Disability claims. Their stroke definition now only requires there to be persisting symptoms for 24hrs, however, it wasn't uncommon in the past for stroke claims to require permanent neurological deficit.
  • Tammykitty
    Tammykitty Posts: 1,005 Forumite
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    What about a private consultation - would Royal London accept that?
  • waamo
    waamo Posts: 10,298 Forumite
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    agrinnall wrote: »
    I'm afraid I find it hard to believe that any hospital would refuse to permit a stroke victim to be seen by a consultant neurologist. If that is really the case you need to be asking your GP for assistance in getting a referral, perhaps at a different hospital.

    Our local paper has been reporting recently that there is no Neurology service in the two local hospitals to me.

    How common this is up and down the county I have no idea but it does seem to be an issue in some areas.
  • kingstreet
    kingstreet Posts: 38,767 Forumite
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    My 2003 Scottish Provident plan (now Royal London) simply states "A cerebrovascular incident resulting in permanent neurological damage. TIAs are specifically excluded."

    It is silent on how long it might take to decide what is permanent and what isn't.
    I am a mortgage broker. You should note that this site doesn't check my status as a Mortgage Adviser, so you need to take my word for it. This signature is here as I follow MSE's Mortgage Adviser Code of Conduct. Any posts on here are for information and discussion purposes only and shouldn't be seen as financial advice. Please do not send PMs asking for one-to-one-advice, or representation.
  • agrinnall
    agrinnall Posts: 23,344 Forumite
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    waamo wrote: »
    Our local paper has been reporting recently that there is no Neurology service in the two local hospitals to me.

    How common this is up and down the county I have no idea but it does seem to be an issue in some areas.

    It's unfortunate, and a failure of management, but I can believe that is the case. However, that shouldn't prevent a referral being made to a hospital that does have a Neurology service, even if that requires a longer journey to get there.
  • sheramber
    sheramber Posts: 19,131 Forumite
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    Weighty1 wrote: »
    Actually, it's page 33 which is the relevant one as page 41 relates to Total & Permanent Disability claims. Their stroke definition now only requires there to be persisting symptoms for 24hrs, however, it wasn't uncommon in the past for stroke claims to require permanent neurological deficit.

    The strike definition does not mean there is cover. It is merely explaining what a stroke is.

    The policy only covers permanent disability and the last paragraph applies

    For more information on what we mean
    by permanent and neurological deficit with
    persisting clinical symptoms, please see page 41.
  • sheramber
    sheramber Posts: 19,131 Forumite
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    agrinnall wrote: »
    It's unfortunate, and a failure of management, but I can believe that is the case. However, that shouldn't prevent a referral being made to a hospital that does have a Neurology service, even if that requires a longer journey to get there.

    The problem may be that the hospital do not consider a referral is necessary for his ongoing treatment.
    The referral to a consultant is for a private matter and therefore the NHS may not be able or willing to pay for that.

    It may have to be a private referral.
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