Your browser isn't supported
It looks like you're using an old web browser. To get the most out of the site and to ensure guides display correctly, we suggest upgrading your browser now. Download the latest:

Welcome to the MSE Forums

We're home to a fantastic community of MoneySavers but anyone can post. Please exercise caution & report spam, illegal, offensive or libellous posts/messages: click "report" or email forumteam@. Skimlinks & other affiliated links are turned on

Search
  • FIRST POST
    • ChickenMan
    • By ChickenMan 1st Jul 18, 11:50 AM
    • 2Posts
    • 0Thanks
    ChickenMan
    Re: Critical illness/life insurance problems
    • #1
    • 1st Jul 18, 11:50 AM
    Re: Critical illness/life insurance problems 1st Jul 18 at 11:50 AM
    Hi, I would appreciate any advice, & will try to describe the events as accurately and concise as I can. If I post this in the wrong forum, I will appreciate some guidance as to where it should be.
    In 1995, my wife & I took out a joint Critical Illness with Death insurance policy, with, whom we were advised (by the Life Insurance broker, we placed the business through), was one of the new big companies branching into critical illness cover.
    At the time, we were both 35 years old, & whilst I worked full-time in an engineering superavisory role, my wife had started a retail business. We have 2 children, then aged 5 and 2 years respectively. The business was only extremely small – and we were advised that this Critical Illness/Life Insurance was essential, in the awful event of any serious illness in the future, to our children or ourselves.
    All the reasons for taking out this policy were explained to the young Insurance broker. He then worked for a fairly largish local insurance broker, whom we had previously taken various other insurances out with.
    All was well, thank goodness, until in approx. 2002, my wife was forced to close our shop, due to undiagnosed and critical (and complicated) gallbladder disease, which eventually involved damage to her pancreas.
    Eventually having to plead to be referred to a larger more specialized hospital, for life saving surgery.

    As my wife was not diagnosed with cancer, etc., we did not claim on the insurance.

    Over the next several years, we struggled on. However, in late 2011, after increasing leg Immobility, etc. issues, and severe worsening “electric shock” type pain down her neck and body, she was admitted into hospital. We were advised by a new to the area Neurologist that he was 95% certain that she had M.Sclerosis. When she was admitted, she was unable to walk, or balance, and her legs kept giving way, causing bad falls.
    She was kept in hospital for approx.. 2 weeks, and one of the medications that was prescribed were Steroids. Within days, she was managing to walk again, albeit with a frame.
    We were advised that her eyes were also affected. (Bi-lateral Intranuclear Ophthalmoplecia).
    She returned home, and slowly began to recover. But approx. 6 months later, she was admitted into hospital on various occasions, with infections, flare up’s of immobility, and increasing electric shock buzzing down her neck, burning/then freezing leg sensations, etc., etc.
    We had notified the Insurers about her possibly having M.S. as we had been advised that we were covered for this. However, because of her continuing bouts of further ill-health, some of the tests required to confirm a definite diagnosis of M.S., were delayed.
    Unfortunately, my wife’s health continued to deteriorate. To such an extent, that following emergency hospital admittance in September, 2012, she became seriously was admitted into ICU, suffering with sudden & severe seizures. The first period of coma was approx. 2 days. She then rallied, but a few days later, she fell into a more lengthier & more serious coma. For over 5 days, we were advised that her life hung in the balance. She was on full life support, and placed on a ventilator. Her GCS level was just 8/15, & we were advised that even if she did wake up, she would probably be brain damaged, etc. During this stage, TWICE my daughters, myself & her parents/siblings, were called to the hospital. Eventually, on the Friday, we were advised that if she did not respond within the following 48 hours, that her ventilator, etc., would be removed. We were advised to “expect the worse” .... We were all absoloutely devastated. However, after an emotional & extremely difficult several hours, I phoned the hospital consultant & advised him that in no way did the family agree to the “DNR” approach.
    But then, on the Sunday, a miracle happened – she opened her eyes for the first time in weeks ! We were absoloutely estatic ! .It was, however, extremely evident that she was still seriously ill. Although she had began to open her eyes, she could not speak, or eat/drink, move around very much. It was a long slow recovery process, but eventually she was well enough to be transferred to HDU, etc. but after almost several weeks, in hospital, we were able to bring her home !
    We contacted our Critical Illness cover Insurers to advise that the further tests re: Multiple Sclerosis, had been delayed due to my wife suffering a severe coma and of being in hospital for many weeks.
    But The Insurers then contacted us to say that we should file another claim, because the policy covered “Coma”...
    In approx. November, 2012, we submitted a claim to them, regarding this. My wife’s Consultant who cared for her during the Coma, wrote a thorough report to them. A few weeks later, came the devastating result that her being in a "longer period" of Coma, did not meet their “criteria”. EVEN though she had been in what her Consultant insisted was a "DEEP COMA".
    We complained, and they agreed to "reconsider" the claim for Coma, if we could provide further information. They then wrote to the Consultant again, who provided another report. Which the Insurers then informed us AGAIN, did not meet with their "criteria". We approached them again, requesting an explanation of just WHY they considered this to be.
    We also had given them our written permission for them to access my wife's medical records.
    Unfortunately, my wife's health has continued to significantly deteriorate, since the Coma in late 2012. After the Coma, she began suffering with worsening memory problems, which are now significant.
    She then began to lose even more mobility, and began suffering with serious falls. Between approx. 2013 and July, 2017, she has broken both of her legs in various areas, in SEVERAL DIFFERENT PLACES. During which time, she has had to endure approx. TEN different LENGTHY & EXTREMELY PAINFUL CORRECTIVE OPERATIONS.
    In approx. 2014, we were advised that my wife was now also suffering with advanced OSTEOPOROSIS. Ever since, she has had to take high-dose medication, to help control her condition.
    As previously mentioned, she has now also suffered for many years, with Gallbladder related Pancreatic damage (local hospital damaged pancreatic bile duct during investigation) & now suffers with Chronic Pancreatitis, for which she has to take a large amount of medication to help control the pain . (She has also lost approx. 9 stones in weight, without even trying, over the last several years.)
    Last year, I myself had to take Early Retirement. My wife was unable to look after herself., anymore. She now requires more or less around-the-clock care.
    In 1995, we NEVER, EVER, envisaged having to live in this kind of situation - we were led to believe that in taking out this insurance, if we DID suffer serious illness, we would be "covered". Whilst the initial premium for 10 years was only approx. £33 per calander month, the premium has increased in the past 13 years, AGAIN & AGAIN & AGAIN.... In 2 weeks time, unless we increase the premium by another 20%, the cover (which includes LIFE cover) will be reduced by approx. £7,000.
    They have "forcasted" that in increasing the premiums by 20% it will "safeguard" our sum insured for approx. 5 years. If we don't, because of our increasing age, in approx. 2 years time, we will face another massive hike in premiums, etc.
    We feel that, because we have NOW PAID IN APPROX. £25,000 IN PREMIUMS, since 1995, we have no other option but to now agree to pay the increased premiums (yet again) - which will now be almost £200 a month, from July, as "at leasT" we still have the life insurance aspect of the policy. (Which is the only Life Insurance we actually have).
    So, we feel like we are now waiting to die...
    I am so sorry that this post is so lengthy, but hope it is realised how DESPERATE we now are ... We are now facing what could become an impovorished and retirement.
    The Insurers are aware that we are now considering making a complaint. But because of the terrible ensuing & serious health problems my wife has suffered, since the coma, & all the terrible upheaval her poor health has caused, we have NOT been in a position, to complain beforehand about the Coma Claim being refused, back in 2012/2013.
    Although the Insurers DID state in January, 2013 that their CMO had requested her medical records, they never contacted us again about the claim.
    Over the years, we have tried several times to speak with the Insurance Broker who sold us the policy in 1995. The existing Company he then worked for has now folded/sold out, etc. & this chap is now an independant "Financial Advisor". He has given us brief advice, BUT has made it quite clear several times now, that he cannot help further... At one stage he actually advised us that if we could not now afford the now expensive premiums, to cancel the policy ...
    What a pity he didn't enlighten us in 1995, of the possibility of this C.I. insurance probably NEVER paying out, however terrible a future illness may become...
    Many thanks for persevering in reading this - any constructive ideas gratefully accepted.
    We have recently now notified the Insurer again, that we now wish to have the claim reconsidered/looked at again... We have applied to the hospitals involved, to request copies of ALL of my Wife's medical records & are now await the receipt of these. Obviously, because of how critically ill my wife was, etc., this is taking a little while for the hospital to gather all the relevant information together.
    We DO have "Legal Expenses" Insurance connected to our Home Insurance Policy, but do not know whether if this Insurer will actually give advice / or help in putting together a "case" to the C.I. Insurers ?
    And in amongst all of this worry, is also all the personal worry, not only about my dear wife's worsening health and mobility problems, BUT ALSO the increasing worry of our financial position.
    We are also not happy at all about the lack of support now, trom the F.A., who sold this insurance to us, in 1995. (But he has made sure that the Insurers are aware that he is now again our F.A., so will probably be receiving a fee from the Insurers, each year) - even though he isn't willing to help further...
    So sorry, folks about the length of all this. But we are now both feeling desperately anxious about the future. If we had known back in 1995, the heartache and pain, if you need to claim, involved with this type of insurance, we would NEVER EVER have taken the policy out. We would have been far better off, saving the equivalent amount of premium money each month, into a savings account, and just taking out Life Insurance, which would of saved us a lot of money.
    I look forward to any advice given - we are aware that time is now of the essence, in having this looked at again. As explained, we have not been able to deal with this earlier, due to the severity of my wife's now complex ill-health problems.
    Kind Regards, ChickenMan.
Page 1
    • Nearlyold
    • By Nearlyold 1st Jul 18, 12:23 PM
    • 1,091 Posts
    • 919 Thanks
    Nearlyold
    • #2
    • 1st Jul 18, 12:23 PM
    • #2
    • 1st Jul 18, 12:23 PM
    Sorry to hear of your difficulties. Without seeing the full definitions of the covered illnesses and the medical reports from the consultants etc its difficult to advise. If your wife's condition meets the insurers stated criteria in the policy terms and conditions and they are refusing to pay, your best way forward, if you have not already done so, is to put in a formal complaint to the insurer and then follow up by referring your complaint to the Financial Ombudsman Service if you don't receive a satisfactory outcome from the insurer. Please remember that your critical illness policy only covers the illnesses as listed in the policy terms, it won't cover other conditions no matter how painful or distressing they may be (unless they give rise to a claimable condition).
    Last edited by Nearlyold; 01-07-2018 at 12:49 PM.
    • dunstonh
    • By dunstonh 1st Jul 18, 1:06 PM
    • 93,398 Posts
    • 60,903 Thanks
    dunstonh
    • #3
    • 1st Jul 18, 1:06 PM
    • #3
    • 1st Jul 18, 1:06 PM
    Critical illness policies cover a defined list of illnesses. They are required t to publish the list. If you suffer an illness on the list then you are covered. If you suffer an illness not on the list then you do not.

    The type of policy you have was going out of date by 1995. Although it was still typically sold by some tied salesforces up to around 1999. It probably explains why the current adviser cannot do anything. Policies sold via salesforces cannot usually be serviced by IFAs. It is just information only. There is really nothing the adviser can do for you.

    if you need to claim, involved with this type of insurance, we would NEVER EVER have taken the policy out. We would have been far better off, saving the equivalent amount of premium money each month, into a savings account, and just taking out Life Insurance, which would of saved us a lot of money.
    I have dealt with far more CIC claims than Life assurance claims and the vast majority were successful. It is very much a black and white criteria list. The plans are not all equal either. There can be a very wide difference in the coverage and terms. A minimum standard was put in place many years ago but only applied to plans taken out after that date.
    I am an Independent Financial Adviser (IFA). Comments are for discussion purposes only. They are not financial advice. If you feel an area discussed may be relevant to you, then please seek advice from an Independent Financial Adviser local to you.
    • Weighty1
    • By Weighty1 2nd Jul 18, 10:45 AM
    • 334 Posts
    • 137 Thanks
    Weighty1
    • #4
    • 2nd Jul 18, 10:45 AM
    • #4
    • 2nd Jul 18, 10:45 AM
    What is the reason for the coma claim being turned down ie. how did it NOT meet their definition?

    Also, it might be worth checking whether your wife has "Total & Permanent Disability" included on the plan. This could be another avenue for a claim and one which doesn't need a specified condition to be claimed upon but would need a consultant to confirm your wife is totally and permanently disability to a specified criteria (the criteria can be different depending on the provider/occupation)
    • kingstreet
    • By kingstreet 2nd Jul 18, 12:17 PM
    • 33,689 Posts
    • 18,268 Thanks
    kingstreet
    • #5
    • 2nd Jul 18, 12:17 PM
    • #5
    • 2nd Jul 18, 12:17 PM
    What happened to the MS claim/diagnosis?
    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.
    • ChickenMan
    • By ChickenMan 6th Jul 18, 12:27 PM
    • 2 Posts
    • 0 Thanks
    ChickenMan
    • #6
    • 6th Jul 18, 12:27 PM
    • #6
    • 6th Jul 18, 12:27 PM
    HEARTFELT THANK YOU for reading & the replies. Unfortunately, I have not been able to reply until now, as it has not been a very good week, for us...

    At the moment I am surrounded by over 3 reams full of my wife's medical notes which have now arrived - just don't know what to look for, or where to start... But just KNOW that somehow, somewhere, something MUST have been misinterpreted... (Looking for a needle in a haystack springs to mind ! )

    In the meantime however, I just wanted to clarify further the points raised -

    DUNSTONH explained - "The type of policy you have was going out of date by 1995. Although it was still typically sold by some tied salesforces up to around 1999. It probably explains why the current adviser cannot do anything. Policies sold via salesforces cannot usually be serviced by IFAs. It is just information only. There is really nothing the adviser can do for you."

    THANK YOU - But Sorry to be so nieve, but what exactly is/were "tied salesforces" ?
    The Commencement Date of the Policy was 01/07/1995. So if we WERE sold it via a TSF, does this mean that we cannot ask the FOS to help, if the Insurers still won't "budge" ?

    Weighty1, asked - "Also, it might be worth checking whether your wife has "Total & Permanent Disability" included on the plan."

    Unfortunately, No ! We were both refused this type of cover.

    kingstreet asked - "what happened to the MS claim/diagnosis?"

    Unfortunately, we have NEVER been able to receive a DEFINATIVE diagnosis - even though my wife's neurological state has progressively deteriorated. Because of the severity of her Coma, the hospital involved focused on trying to help revive her. (During the time she was in a coma, they performed 2 Lumbar Punctures. to rule out Meningitis. To the best of our knowledge, these too were inconclusive. HOWEVER, after her returning home in late 2012, it took several months, for her to be well enough to cope with further nuro.tests to aid a "definative" diagnosis of MS. This involves a 4 hour return motorway, etc. journey to our nearest available hosp. where she could undergo relevant, 2-3 hour specialised tests. Again, the initial tests were inconclusive. So several weeks later, we had to return again, for these tests to be repeated. THIS time, however, she was instructed to take a sedative. But, AGAIN, "inconclusive" results.

    By this time my wife was still absolutely shattered. The MS consultant became extremely unhelpful. He was supposed to keep "regular" checks on her, BUT very soon the appts. dried up & for 2/3 years she did not see him. We just muddled on the best we could.

    As mentioned, Unfortunately, during the years since her Coma ordeal, she has had over several major various leg fractures (at one stage, we were warned that amputation may be necessary of one of her legs).

    EVERY time she has been in hospital due to due to the major fractures, etc., we have pleaded with the Drs. to try & do some of the tests she was waiting for/needed. But obviously, because she was always on Orthopedic wards, the MS was not their priority.

    Approx. 2 years ago, we again had to plead for re-referal to this Neuro. who then diagnosed Peripheral Nephropathy.

    Last year, There was also a suggestion about Guillain-Barr! syndrome. But again, my wife was under orthopedics, for hip revision, etc. So once again, it was never followed up.

    My wife is now an emotional and physicial wreck. Whilst we know that she must ask for a "2nd opinion" from a Neurologist, we also know that this will mean more long and exhausting hospital visits, to "out of the area" hospital clinics, for complicated tests, consultations, etc. etc.

    Because of the severity of my wife's Osteoarthritis, and the ensuing leg fractures, & continuing risk thereof again, we have both almost reached the end of our tether...

    My apols. for rattling on again, but oh! ....

    However, DOES ANYONE think that the Legal Expenses Insurance Cover, we have via our Home Insurance, will be able to help us with this?

    (As mentioned above, We have now received a HUGE batch of copies of my wife's medical notes, covering her period of being critically ill - and also the run up to it . We requested all copies of the ICU notes especially of the many days she was in a coma & ventilated. There is approx. 3 reams of notes, here.

    We intend to go through the notes regarding her GCS, during that week. We are sure that within those notes, we may be able to prove that she indeed WAS within their "criteria" for Coma...

    Again, Many thanks, for your suggestions. And if anyone can offer any more advice please ?

    Kind regards,

    Chicken Man
    • dunstonh
    • By dunstonh 6th Jul 18, 12:46 PM
    • 93,398 Posts
    • 60,903 Thanks
    dunstonh
    • #7
    • 6th Jul 18, 12:46 PM
    • #7
    • 6th Jul 18, 12:46 PM
    THANK YOU - But Sorry to be so nieve, but what exactly is/were "tied salesforces" ?
    The Commencement Date of the Policy was 01/07/1995. So if we WERE sold it via a TSF, does this mean that we cannot ask the FOS to help, if the Insurers still won't "budge" ?
    Tied salesforces are agents of a particular insurer or a panel of insurers. i.e. they can only sell their own product. They are not independent. The product providers that operate a tied salesforce typically had a version of product that was only for their salesforce. So, if you later see an independent, they cannot get the product transferred to their agency or obtain any agency rights. They can just get information only (and often then only for a limited period)

    So, whilst the investment backed life/CI plans were going obsolete in the independent market, tied salesforces took longer to react to that change. As the tied agents can only sell that product, they have no choice in the matter (other than change employment!)

    How you buy the product doesn't matter in terms of suitability in the eyes of the FOS. However, if you were to complain that you should have been sold something different, if that alternative product wasn't available to a tied agent then they could never sell something they didn't have available to sell.

    If the complaint to the FOS is about the claim, then none of this matters how you bought it.

    My main point for raising it was to try and explain why the current IFA has virtually no influence or ability to do anything about an old plan sold under a tied service.
    I am an Independent Financial Adviser (IFA). Comments are for discussion purposes only. They are not financial advice. If you feel an area discussed may be relevant to you, then please seek advice from an Independent Financial Adviser local to you.
Welcome to our new Forum!

Our aim is to save you money quickly and easily. We hope you like it!

Forum Team Contact us

Live Stats

116Posts Today

2,249Users online

Martin's Twitter