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  • FIRST POST
    • JessC
    • By JessC 2nd May 18, 5:52 PM
    • 4Posts
    • 1Thanks
    JessC
    Critical Illness reject claim
    • #1
    • 2nd May 18, 5:52 PM
    Critical Illness reject claim 2nd May 18 at 5:52 PM
    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 ?
Page 1
    • agrinnall
    • By agrinnall 2nd May 18, 6:03 PM
    • 21,009 Posts
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    agrinnall
    • #2
    • 2nd May 18, 6:03 PM
    • #2
    • 2nd May 18, 6:03 PM
    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
    • By angrycrow 3rd May 18, 6:34 AM
    • 556 Posts
    • 404 Thanks
    angrycrow
    • #3
    • 3rd May 18, 6:34 AM
    • #3
    • 3rd May 18, 6:34 AM
    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
    • By sheramber 3rd May 18, 1:10 PM
    • 5,256 Posts
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    sheramber
    • #4
    • 3rd May 18, 1:10 PM
    • #4
    • 3rd May 18, 1:10 PM
    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
    • By Weighty1 3rd May 18, 1:37 PM
    • 367 Posts
    • 169 Thanks
    Weighty1
    • #5
    • 3rd May 18, 1:37 PM
    • #5
    • 3rd May 18, 1:37 PM
    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
    Originally posted by sheramber
    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
    • By Tammykitty 3rd May 18, 1:38 PM
    • 594 Posts
    • 1,218 Thanks
    Tammykitty
    • #6
    • 3rd May 18, 1:38 PM
    • #6
    • 3rd May 18, 1:38 PM
    What about a private consultation - would Royal London accept that?
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    • waamo
    • By waamo 3rd May 18, 2:16 PM
    • 4,257 Posts
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    waamo
    • #7
    • 3rd May 18, 2:16 PM
    • #7
    • 3rd May 18, 2:16 PM
    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.
    Originally posted by agrinnall
    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.
    This space for hire.
    • kingstreet
    • By kingstreet 3rd May 18, 2:19 PM
    • 34,134 Posts
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    kingstreet
    • #8
    • 3rd May 18, 2:19 PM
    • #8
    • 3rd May 18, 2:19 PM
    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
    • By agrinnall 3rd May 18, 2:27 PM
    • 21,009 Posts
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    agrinnall
    • #9
    • 3rd May 18, 2:27 PM
    • #9
    • 3rd May 18, 2:27 PM
    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.
    Originally posted by waamo
    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
    • By sheramber 4th May 18, 5:28 PM
    • 5,256 Posts
    • 3,915 Thanks
    sheramber
    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.
    Originally posted by Weighty1
    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
    • By sheramber 4th May 18, 5:31 PM
    • 5,256 Posts
    • 3,915 Thanks
    sheramber
    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.
    Originally posted by agrinnall
    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.
    • JessC
    • By JessC 4th May 18, 5:39 PM
    • 4 Posts
    • 1 Thanks
    JessC
    Thank you all , I have emailed back asking Royal London at what point they feel they would accept these symptoms as permanent ( 6 months , a year) and we are probably resigned to getting an opinion via a private referral .
    Thank you all for your thoughts .
    • danceinthedark
    • By danceinthedark 5th May 18, 9:00 PM
    • 10 Posts
    • 1 Thanks
    danceinthedark
    Not uncommon for claims to be deferred in these circumstances. I!!!8217;d expect they!!!8217;d want to review it in 6 months or so.

    Is he having any ongoing treatment or rehabilitation from other NHS services? Your GP may be able to provide evidence of this to the insurer.

    If he really does not receive any follow up from a neurology clinic, the insurer may be willing to fund an independent examination by a neurologist. This would be purely for the purpose of assessing the claim, not advising on treatment.
    • agrinnall
    • By agrinnall 7th May 18, 9:10 PM
    • 21,009 Posts
    • 16,796 Thanks
    agrinnall
    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.
    Originally posted by sheramber

    That might also be true, if the OP's husband had ever been seen by a consultant neurologist, but as he hasn't I don't see how non-specialist staff can make a fully informed decision on treatment.
    • Weighty1
    • By Weighty1 8th May 18, 8:45 AM
    • 367 Posts
    • 169 Thanks
    Weighty1
    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.
    Originally posted by sheramber
    Unless there was a specific exclusion for stroke (unlikely) then stroke will be covered as CI plans aren't modular. You are either covered for all the conditions or not. The actual definition for a stroke is as follows:

    Definition
    Death of brain tissue due to inadequate
    blood supply or haemorrhage within the
    skull resulting in all of the following:
    • definite evidence of death of tissue or
    haemorrhage on a brain scan; and
    • neurological deficit with persisting
    clinical symptoms lasting at least 24
    hours.
    For the above definition, the following is not
    covered:
    • transient ischaemic attack
    • death of tissue of the optic nerve or
    retina/eye stroke

    There is no mention for it needing to be permanent these days, however, if you read the definition for "spinal stroke" you will see the definition states permanent neurological deficit. If the word permanent isn't in the definition then permanent symptoms aren't needed.

    HOWEVER, as I previously stated, it's unlikely that's the case on an older plan as permanent symptoms were often required meaning that a waiting period before a claim could be made would often occur. Unfortunately, this isn't unusual and I'd still be hoping for a positive outcome, albeit it potentially in a few months.
    • JessC
    • By JessC 8th May 18, 11:47 AM
    • 4 Posts
    • 1 Thanks
    JessC
    Thank you for your reply he has been seen by a consultant neurosurgeon as he needs a brain operation to rectify an area where the stroke was caused . This consultant has referred him to a specialist centre for this .
    • Weighty1
    • By Weighty1 8th May 18, 11:54 AM
    • 367 Posts
    • 169 Thanks
    Weighty1
    Best of luck and a quick recovery for your husband. Based on all the info you've provided I'd be very surprised if it didn't result in a valid claim. Fingers crossed it's resolved speedily and in a stress free manner.
    • Senseicads
    • By Senseicads 8th May 18, 12:05 PM
    • 133 Posts
    • 89 Thanks
    Senseicads
    Let us know how you get on though as I hate never finding out how things worked out!
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