71603members
375692posts
cancel
Showing results for 
Search instead for 
Did you mean: 

Critical Illness Cover - What a Joke!

55 REPLIES 55
lizcat
Member

Re: Critical Illness Cover - What a Joke!

katel31,

I hate to have to say this but I have a feeling the new company may well not pay out as they may treat it as an existing condition as it is on the records with the GP that there has been a 'problem' for a few months. There may also be an exclusion period. However, it will all depend on the questions asked and what you declared at the time of application and the terms of the policy. The old company won't pay out as you no longer have a contract with them (think storm damage claim with house insurance scenario).

Don't take what I've said as definitive but I just don't want you to get your hopes up. It's still worth pursuing with the company anyway as it will depend what info they want from your doctors and how they reply.

Good luck with your treatment in the coming months.

Liz

katel31
Member

Re: Critical Illness Cover - What a Joke!

Hi,

Can anybody help me. I was diagnosed with BC nearly 2 weeks ago and I am currently making a claim for critical illness cover. We had a high level of cover for 3 years but it was due to be renewed in March and due to Financial reasons we changed companies and reduced the level of cover to less than half of what we were previously covered for.

I went to the doctor at the end of March with Breast Pain. I told him that I have been having the pain for many months. I was diagnosed with BC on 6th May. But it is on record that I had the lump for at least 6 months (I never for a second thought I had cancer or I would have been to the doctors a lot sooner)

Anyway I am just wondering could they refuse to pay out and if they do can we claim against the previous company?

Thanks in advance

Osprey
Member

Re: Critical Illness Cover - What a Joke!

Wow!!
Thank you SO much everyone- just put in my claim , it should be fine but you guys have given me the confidence to MAKE SURE it's fine!!!
And yes..I think I wont tell anyone ,although I'm proud of having gotten something right all those years ago!It's hard not to feel you are letting your family down when you feel weak.
Lets face it , the money makes a HUGE difference, knowing the roof will stay over you and your families head.
We all need to stand up for our-selves ;- that way we stand up for each other by setting the right precedent.
a great thread , really really helpful.
xxx

bud932
Member

Re: Critical Illness Cover - What a Joke!

I must gave been one of the lucky ones. I had a critical illness policy and it paid out a month after contacting the company. I had only taken the policy out 6 months earlier. Don't give up on getting the money
Gail

Midge
Member

Re: Critical Illness Cover - What a Joke!

Really pleased it worked out for you. Am sure it will encourage others not to take no for an answers. It's a shame it take that much effort to get what you are owed.

Thanks for the update.

Debx

Alibabes
Member

Re: Critical Illness Cover - What a Joke!

Hooray! A reduced mortgage is still a better bet than a full mortgage so don't beat yourself up!

Ali x

Nicky65
Member

Re: Critical Illness Cover - What a Joke!

Thank you to those of you who gave me advice last year on here and in PMs. After applying for critical illness last August and lots of correspondance and delays, I have finally been contacted and told that they are going to pay up!

So for those of you still struggling with delays - don't give up! keep standing your ground.

I suppose that I should be frustrated with myself for not upping the premiums when we extended the house, as the payment doesn't even cover half of the mortgage, but it is such a relief that I have finally been paid out. I am not used to good news! I burst out crying after I'd put the phone down.

Take care all and good luck for those of you still pursuing what you have paid up for!

N x

oscarbailey
Member

Re: Critical Illness Cover - What a Joke!

Absolutely appeal. Non-disclosure used to be used as a get out often, but the ombudsman came down really heavily on the insurance companies for this.
Non disclosure should only be used to reject a claim when it was deliberate... for example, finding a lump, going to doctor, getting critical illness cover, making a claim. Having a heart attack, getting insurance, making a claim if a subsequent heart attack.
The age of your policy should also go in your favour - there is no way it could be deemed deliberate non disclosure and claim 12 years later.
Agree with Midge, cyst and cancer are completely unrelated.
I would ask your insurance company to give you a definitive answer in writing asap as you are lodging a complaint with the Financial Ombudsman.
On a positive note, when they pay, they will have to pay interest from the date of diagnosis.
I wish you the very best
Marguerite

Midge
Member

Re: Critical Illness Cover - What a Joke!

Hi Nicky

Sorry about all this. Appeal. My insurance broker said they often turn you down initially, but if you push they back down. My chemo nurse had her clan initially turned down because of non disclosure of an unrelated medical condition and it was overturned. A breast cyst is unrelated. They do not turn into cancer, so have nothing to do with your illness. Getting your original doc is the best way to go. Sometimes the change the wording slightly and that makes all the difference. You deserve this money. Good luck.

Debx

Nicky65
Member

Re: Critical Illness Cover - What a Joke!

Sophie

The man I spoke to this morning said that on the original application it mentioned something about lumps being investigated whether benign or not, I have asked for a copy of the original. I can't even remember it as it was over 12 years ago, I am too honest and too much of a worrier to actively omit things. At the time they aspirated it and wanted to then remove what was left of the lump, but couldn't find it and sent me home. I was certainly never called in for any further scans or treatment (I wouldn't have forgotten that!) At the time I was working full-time (resentfully) to support a toddler and going through a divorce, so remember the lump being ingignificant to me at the time.

Thanks for giving me confidence that I might be able to fight it,

Nicola x

triphazard99
Member

Re: Critical Illness Cover - What a Joke!

Nicky - I'd term this a 'wiggle out' move by the insurance company - a cyst is not and never has been the same as breast cancer - that's like an insurance company claiming that having had bronchitis makes a claim for lung cancer invalid.. they are NOT the same thing.

Appeal, appeal, appeal - and seek legal advice if you can - this is not your fault, or you mis-leading the insurance company - you had a completely different problem. I take it that the investigated cyst was benign, and not cancerous? If so - then you have in no way invalidated your claim - and you need to fight it.

Good luck - I'm sure half the time the insurance companies find spurious reasons to try to refuse, in the hopes that you won't appeal - when you do, they often give in.

Sophie xx

Nicky65
Member

Re: Critical Illness Cover - What a Joke!

So pissed off! and it appears it's my fault!!

After making a claim for a critical illness payout in August, I have now been told that my claim may be invalid! Apparently I didn't disclose on the initial application that I had had a cyst aspirated and investigated in the past. I remember the procedure, but don't remember being asked about it on the form.

I have asked for a copy of my original application, but realise that I now probably don't have a leg to stand on, if this is the case. I am having to wait up to 6 weeks for a report from the hospital that 'treated' me, as my current records only mention the referral.

I feel absolutely awful about it as we desparately need the money as I went part time stupidly thinking that secondary breast cancer in lots of places would NOT be knocked back and the money would not be enough to pay off the mortgage, but would enable us to cover our living expenses if I went part time.

I feel physically sick it's all I have thought about all day, I have a permanent knot in my stomach and can't face eating anything. How could I be so stupid? Do people think it is an attempt to wriggle out? (I know I should have stated this, but don't remember actively omitting it!)should I get legal advice? I think somebody earlier mentioned working in the industry, will I be refused it. Or is there I way that I accept that I may have had higher charges if they had known and negotiate a reduced payment. How does it work?

Sorry if this is a dis-organised post, but I can barely see the screen through my 'sorry for myself tears' and my head is all over the place.

Glossy
Member

Re: Critical Illness Cover - What a Joke!

I was with a particular insurance company (whose name I will not mention) but because I had not been paying long enough when I was diagnosed i did not get a payment. They will not now cover me for breast cancer but will for other cancers. Does anyone know of an insurance company that will cover me if this should come back?

pcb1973
Member

Re: Critical Illness Cover - What a Joke!

Hello all, I am afraid I work for one of these insurance companies. I will not mention the company but hopefully give you a bit of an insight. The Critical Illness policy was introduced to the UK in the mid 80's. As you can imagine a diagnosis of cancer back then would have a different outcome. With advances in Medical science diagnosis is happening earlier and earlier so the prognosis is better.

This was costing the insurers more and more money in claims so they changed the definitions to reduce the claims. This was the only thing they could do because of the constraints of the contract which pay either nothing or everything.

The forward thinking insurance companies now offer what is know as severity cover. Where the less invasive illnesses are covered by a lower payment. There is a company that covers lumpectomy, partial and full mastectomy of a DCIS but subsequently pays much more when the cancer is invasive.

As with anything there are good and bad contracts. The best thing to do is speak to a reputable financial advisor or insurance specialist. If they use the phrase "this is the best because it is the cheapest" then walk away. There are critical illness contracts that cover 25 conditions and there are ones that cover 161. The price difference between them can be as little as 5%

It is a mine field and I do empathise.

I hope this was of help.

Nottsgal
Member

Re: Critical Illness Cover - What a Joke!

Oh Lulu, that's bad that you had to wait when you weren't getting sick pay. I'm still on full pay at the moment as I've only been off since my mx on 13th Oct. I'm not sure how many months before it gets reduced to half pay but I might be able to do some work while I have chemo etc. Anyway the money will definitely help and secures our house as my husband is paid a lot less than me and could not afford the mortgage on his own.

Wizzbaby - glad I'm not being weird about this.

xx

Lulu34
Member

Re: Critical Illness Cover - What a Joke!

nottsgal so pleased they have paid out...

its one less thing to worry about... i was a single mum and had just finished 4 years at uni so hadnt paid enough NI conts so wasnt getting any DSS money when i was diagnosed first time round 4 years ago.... so it was a real relief to have my mort paid.... although the 3 months from diagnosis till pay out seemed to last for ever.

Lxxx

Wizzbaby
Member

Re: Critical Illness Cover - What a Joke!

Hi Nottsgal
I too got a payout and didn't mention it to anyone other than my husband. Only one friend actually asked about it directly and I was honest with her.

Nottsgal
Member

Re: Critical Illness Cover - What a Joke!

I am getting a payout from the critical illness insurance (Reliance Mutual). I am pleased but haven't told anyone, other my husband of course, as I don't want people thinking I'm rich, or lucky to have so much money fall into my lap. But I can tell the people on here :0)

Nottsgal
Member

Re: Critical Illness Cover - What a Joke!

Thanks Lulu,
I didn't know that.

I can see this forum is going to be great for getting to know all sorts of stuff. I'll try to be helpful to others who ask things but I don't know much yet. 6 weeks ago I didn't even know I had cancer.

Lulu34
Member

Re: Critical Illness Cover - What a Joke!

nottsgal sounds like your cancer is invasive and not in
situ as invasive cancer gets graded 1, 2 and 3 but in situ is usually referred to as low, intermediate and high grade.

so most insurers will pay out for invasive cancer and most wont pay out for DCIS (although as Emma has stated a few will pay out if you fit other criteria).

Lx

Nottsgal
Member

Re: Critical Illness Cover - What a Joke!

Thanks June and Alibabes, and yes I am probably thinking that since something nasty has happened, the insurance company should give me some money to make me feel a bit better about it all ;0). I know really that it doesn't work like that!

I got the results yesterday and the cancer had been upgraded from a 1 to a 3 (v aggressive) but had not spread to the lymph nodes, so I'm lucky compared to many. The bad news was that because of the upgrade I will have to have chemotherapy, then radiotherapy, then herceptin, then tamoxifen (unless chemo brings on early menopause, in which case it will be aricept).

Alibabes
Member

Re: Critical Illness Cover - What a Joke!

Nottsgal cancer in situ usually means it is non invasive and an early stage tumour.

Critical illness cover was designed to pay out for serious illnesses that may require a long recovery time and extensive teratment. In the case of cancer, it depends on the grade and spread. If you ask your insurer they should be able to provide you with a booklet that goes into detail about their definitions for each illness they cover.

Please don't take this post as belittling your experience in any way, shape or form because any cancer diagnosis is obviously very serious and concerning for the person involved. I am trying to explain it from an insurer's point of view, not a patients if you see what I mean.

Ali

June_BCC
Member

Re: Critical Illness Cover - What a Joke!

Hello Nottsgal

Welcome to the forums, I’m sure other users will be along to support you soon.
In the meantime you may find it useful to contact our free helpline on 0808 800 6000 and ask about 'cancer in situ' as they will be able to explain it to you, opening hours are Monday to Friday 9.00 – 5.00 and Saturday 9.00 – 2.00.

I have also attached a link to our publication on Ductal Carcinoma in Situ http://www.breastcancercare.org.uk/upload/pdf/ductal_carcinoma_in_situ_dcis__mar_08_0.pdf

Best wishes
June, moderator

Nottsgal
Member

Re: Critical Illness Cover - What a Joke!

Hi all,

I sent off my claim form earlier this week but the lady I spoke to kept saying they wouldn't pay for 'cancer in situ'. Does anyone know what this means? To my mind, the cancer is not is situ as I had a mastectomy last week, so either it is gone, or else it has spread (I will find out this afternoon).

I have been paying premiums on my policy since 1995. They went up £2 a month each year, so the current premium is £50 per month - which I think is a lot if they don't pay out now.

snoogle
Member

Re: Critical Illness Cover - What a Joke!

Glad to hear that things have worked out for you with this.

Snoogle
x

emma92
Member

Re: Critical Illness Cover - What a Joke!

Further to my previous post, I found out today my insurance claim has been approved! It has taken Pru a day to assess the claim from receipt of my treating specialist's form ANC I'm very pleased! Unfortunately I didn't have DCIS so that was irrelevant but am covered for my cancer type. I hope other people have successful claims and be reassured it's not always bad!

Emma

emma92
Member

Re: Critical Illness Cover - What a Joke!

Correction my insurance covers DCIS where mastectomy required - like mine! Had to double-check after reading everyones messages!

E

emma92
Member

Re: Critical Illness Cover - What a Joke!

I'm just about to put in my claim with Pru-only had our first flat for six weeks and only paid one premium on the policy so hoping it will pay out! I'm so worried it won't! Have family who will help financially but the money will take away a huge weight! I'm not sure what I actually have yet until MRI and op but my insurance covers DCIS thankfully so fingers crossed! I think it is awful how they will find any way to get out of paying and, if that happens to me, will def pursue litigation as you do take these things out so they are there if you need them! I hope that everyones problems get sorted and these big multimillion conglomerates start thinking about the individual!!!

Good luck all!

hemajo
Member

Re: Critical Illness Cover - What a Joke!

I can believe how reluctant insurance companies are to pay out. I have a good gp so I think I will talk to her about it. Fingers crossed!
Helen

signet
Member

Re: Critical Illness Cover - What a Joke!

This is v helpful. We cancelled criticalillness a yr prior to dx on financial advisors advice!!!!! However I am claiming on life based on terminal dx with my liver mets. Rang me Friday saying there is an entry in 2005 saying I was given smoking cessation advice which is bonkers as I have never smoked so now it's my word against a gp entry. I left that gp as ge failed to act over 8 months on the symptoms. Repeatedly saw him about re breast cancer.

Called his practice who knew me and said that not only was I preg on the date stated but my records clearly show non smoker so they're hinging it on tha one thing. Also guy at legal and general said they want my nex scan result as if it shows positive response to treatment they won't pay anyway as it's an accelerated death benefit and it's unlikely I will die within year!!!!

What can I say but my luck sucks. My pal claimed on my advice with aviva and got money at weekend. No questions and four weeks in all. She got scan last week showing massive reduction in cancer.

Lynn xxxxx

hemajo
Member

Re: Critical Illness Cover - What a Joke!

Hi,
I have just been reading a few posts in this section of the forum, and it has prompted me to ask for any comments or advise about whether I should try and claim on my life insurance policy.
I was diagnosed with secondary breast cancer in May. I have quite extensive bony secondaries, no liver or lung involvement. I have had some radiotherapy and am on bisphosphonates and Letrozole (which may or may not be having any effect possibly, but too soon to be sure).
My life policy is for a fixed term - until May 2011. I phoned them to ask them how 'terminal' was defined, and was told less than 12 months. I asked my macmillan nurse how the DLA application was worded as that defines it as 6 months. He said he words the claim 'wouldn't be surprised if (name) were to die within the next 6 (12) months. I discussed this with my oncologist and he felt he couldn't say this (which, of course, is probably good news for me!). I don't understand though, how the DLA was approved on a 6 month definition under these circumstances. I wonder whether to ask my GP instead. My macmillan benefit officer suggested I try different doctors until I find one who says yes!
Any ideas??
Helen

Steph10
Member

Re: Critical Illness Cover - What a Joke!

I had a critical illness policy with Scottish Provident and on reading old posts about how companies are reluctant to pay, I thought I'd have a fight on my hands. My GP also phoned me to tell me that because I'd seen a GP before taking the policy out with a dimple on the boob, that the insurance co. could say this was a symptom even before I was properly diagnosed and not pay out. When I first went with the boob dimple, the gp didn't see it and therefore I wasn't referred on at that stage.

But surprisingly, the company paid up and now we are now mortgage free. It took a while with statements having to be gathered from GP and surgeon. We also had our monthly payments refunded from the date of diagnosis too. We'd taken out the policy about 18 months before my diagnosis when negotiating a new mortgage.

tors
Member

Re: Critical Illness Cover - What a Joke!

Just wanted to add that if your insurance company are still refusing to pay out for suspect reasons, then you can litigate against them to make them pay out. There is a whole area of law which deals with insurance litigation and a judge can find in favour of a claimant who says that the company should be paying out and are breaching the terms of the insurance policy in not doing so. Its worth keeping records of everything you say to the company and get as much in writing as possible, because it always helps a bit to be able to prove when the company has treated you shabbilly, especially in these circumstances.

It is well worth decent research into finding a good solid firm to act for you as its not soemthing most high street solicitors are likely to be sufficiently experienced in to do your claim justice. If you are in a trade union, they may well fund you and arrange for a good firm to act for you. Occasionally,you may find appropriate legal cover on other policies you may have, like house insurance. Its not an easy route, but definitely something to bear in mind that the companys final decision doesn't have to mean the end of the road.

And if they refuse you bacause you have changed your name without telling them, they are totally off the mark as there is absolutely no basis for this!

snoogle
Member

Re: Critical Illness Cover - What a Joke!

Mine paid out immediately for critical illness policy but were a little reluctant to pay out on the terminal illness clause on my life policy. They paid out in the end though, but as it was decreasing term they probably saved some money in the delay.

Snoogle
x

cat107
Member

Re: Critical Illness Cover - What a Joke!

Mine paid out no problem. There was a short delay when they were waiting for info from the docs. I had 2 policies from when we remorgaged and the 2 companies shared info. Mine was also in the the lymph nodes and that is classed as invasive.

carmcg1
Member

Re: Critical Illness Cover - What a Joke!

I was diagnosed 1st June 2009 and paid out 4 weeks later with one months interest on the money plus refund of 2 months premium!!! I cant believe how much insurance companies try and wriggle out of paying ci out, let us know how you get on

take care

Carol xx

Midge
Member

Re: Critical Illness Cover - What a Joke!

Hi Nikki

Invasive means IDC- invasive ductal, or ILC- invasive lobular, or IBC-Inflammatory. I think they wont pay out for DCIS etc - as they are in situ so are not supposed to be able to spread. Hope your claim gets sorted quickly. dx

NIM41
Member

Re: Critical Illness Cover - What a Joke!

Hi
I was diagnosed 4 weeks ago and sent off my form last week. Good to hear it may take some time until the consultant replies. Also re: definition of invasive cancer, I think this may be Barclays' 'get-out' clause. Mine is in my lymph nodes which means invasive?
Hope I'll get it sorted!
Nikki

dotchas
Member

Re: Critical Illness Cover - What a Joke!

Caroline,it must depend on the company but I was refunded my premiums I paid between diagnosis and claim settlement.
Krissy,If you have been diagnosed with an invasive cancer like you have they will find it difficult not to pay unless you gave some wrong info on the original application re family history.
I had problems previously with life insurance as I have a heart murmur,some companies refuse to cover me and some wanted to charge an arm and a leg.Eventually Standard Life covered me no problems and gave me my critical illness policy.But maybe if I hadn't been straight with them they would have been able to wriggle out of paying(If not BC,maybe if I had a heart related claim)
Good luck,I hope you get it sorted
Dot
xxx

katinthemiddle
Member

Re: Critical Illness Cover - What a Joke!

Thanks everybody for your responses. I'm not sure when I will find out if they are paying or not. Its now been 6 weeks and the surgeon still hasn't returned the forms and now the company are requesting information from my doctor. A friend of mine has a son who works for an insurance company and he told her that they are told to look through every claim with a fine tooth comb to look for ways not to pay. I have to say, I'm not impressed with my company. I just hope I get the result I need.

Thanks again

Krissy x

carolihne
Member

Re: Critical Illness Cover - What a Joke!

Hi there,
I eventually got my payout - took about three months to sort out though. Bewarned though that you have to keep paying the premiums while it is being sorted and you don't get this money back ie they pay out to date of diagnosis and there is no refund on additional payments made till date of settlement - does this make sense? seems most unfair cos the longer they delay making a settlement the more money they get
cheers
Caroline

bennyboo
Member

Re: Critical Illness Cover - What a Joke!

Hiya,

Sorry to hear you're having trouble with your claim. My poliy was with Aviva and they were great. The only delay with my claim was waiting for report from surgeon as he wouldn't send report until after op results, once he did report though they paid out really quickly.

If you purchased your policy through a financial adviser he will be able to talk to the company for you and can even act on your behalf with regard to the claim. If not the CAB or Macmillan financial advisor may be able to help.

My understanding is that the policy will have very specific terms for "family" and also for nature of cover, for example my policy said "invasive carconoma". If you get a copy of the policy from them you should be able to speak to your Onc and ask them to confirm that you meet the definition.

The reason I suggest a third party to act on your behalf is that the black and white nature of the way they validate the claim can seem exceptionally callous if you feel unsettled, which we all do following diagnosis.

Sorry if you already knew and had tried all of this and good luck.

Joxx

taxi73
Member

Re: Critical Illness Cover - What a Joke!

I have had no problems getting my payout..it's on it's way to the bank as we speak.I had the letter from insurance stating the payout this morning and that it was sent to bank on thursday.
They were really quick as I was only diagnosed about 6 weeks ago.

There will be no problems if you anwered the medical questions correctly at the time of taking the policy out.

Good luck..keep us informed

Lulu34
Member

Re: Critical Illness Cover - What a Joke!

i was with halifax and they (well bank of scotland) had ballsed up my mortgage but thank goodness they had actually sorted out the critical illness an it was in place from the november... the mortgage was only sorted in march and i was diagnosed in the april....

if the had ballsed up the critical illness they wouldnt have paid out because i would have been diagnosed too soon after taking out the policy.

anyway i put the claim in and still had to keep up my monthly payments until the claim was completely sorted out in the july.

if you have been diagnosed with DCIS only most companies wont pay out as its not considered a critical illness and only invasive cancers will be paid out as they have the possibility of secondaries which DCIS doesnt and its that basis that makes it critical.

hope you can get it sorted.

Lulu x

katinthemiddle
Member

Re: Critical Illness Cover - What a Joke!

Thanks Isabelle. I'm really pleased you got your claim sorted. Good luck xx

izzypal
Member

Re: Critical Illness Cover - What a Joke!

Hi Krissy,
I have recently heard that my ins company has accepted my claim and are due to start my payments this week.
I've been paying into it for the last 9 years so I would be most upset if I didn't get it.
My Doctor charged me £30 just to sign the form for me, bit of a cheek I thought!
It will be very welcome when my payments begin to come through.
I hope you are able to get your's sorted out soon.

Best Wishes,

Isabelle xxx

katinthemiddle
Member

Re: Critical Illness Cover - What a Joke!

Midge - Hope you get sorted. I'll let you know how I get on....take care

Krissy xx

Midge
Member

Re: Critical Illness Cover - What a Joke!

What a pain Krissy

Sorry they are so sneaky. I know on my report from the surgeon he has noted that I have no relevant family history but I am aware that there is some. But if the surgeon has said that I hope the accept it . I don't know what the gp said but I think I might request a copy of the form.

I hope you get it sorted. Dx

katinthemiddle
Member

Re: Critical Illness Cover - What a Joke!

Hi Nicky and Midge

God its awful isn't it? Mine is really complicated but to break it down they are trying to get out of it on a family history issue. Its so annoying.

I can remember reading about name changes, etc so not sure what they ultimately decide but when you think about it, these companies are worth a fortune and lets be honest, most people never need to claim. So in the whole scheme of things, when they do get asked to pay out, its minimal in their coffas..............

Midge
Member

Re: Critical Illness Cover - What a Joke!

Forgot to add they sent a form to surgeon and gp. Getting them filled in was like getting blood from a stone. It took 9 wks from them getting the forms to sending them back. Dx