Forum

Critical claim rejected - help!

Hi,

I have just found out today the my critical claim that I had through Work has been rejected. They are saying that as I had a pre existing condition prior to starting with me company and being diagnosed they won’t pay out. I was not diagnosed with MS before I started at my company and the neurologist at the time had discharged me after a single episode which was not MS as it wasn’t multiple and I had no changes after a year.

i wouldn’t have been able to claim after what they are calling a pre existing condition as it wasn’t MS and they are saying I can’t claim now - help! does anyone have any advice on how I can appeal this?

thanks in advance! Natalie

I am so sorry to hear this. No suggestions to offer, I’m afraid, except that you pursue your options for appealing for all they’re worth - this is such an important thing that it is worth fighting for. Whether you will have any luck with a previous recorded episode of ?demyelination (or similar) on your records, I couldn’t say, but it has to be worth your best shot.

Good luck.

Alison

get legal advice.

then appeal.

good luck

You may have to fight your corner; don’t give up; see below; different circumstances but just to show you must not take no for an answer.

MS patient wins cash battle with insurer
A woman with multiple sclerosis has won a legal battle with an insurance firm that refused to pay out under critical illness policies after she was diagnosed with the illness.

The exact worth of Valerie Cuthbertson’s Court of Session victory over Friends Provident has still to be finalised, but she should receive about a £50,000 lump sum and a weekly payment of £139.

The court heard that the firm had used questionable methods in its search for evidence to invalidate the policies and had latched on to entries in Ms Cuthbertson’s medical records. She had not disclosed a handful of appointments with her doctor in the application forms for the insurance, but the judge ruled that she had no reason to believe those were of any importance.

Ms Cuthbertson said: “It has been a long time, five and a half years, but I felt I had to take it all the way because they were wrong. I felt I had a really good case, and I think for anybody else going through this sort of thing, they will take heart from this.”

Ms Cuthbertson, 39, a theatre manager from Glasgow, took out the cover in 1994. Nearly two years later, she was diagnosed with MS but did not appreciate that the policies covered her condition and made no claim.

Then, in 1999, a representative of Friends Provident called on her to review her financial affairs. He arranged for a claim form to be sent to her and Ms Cuthbertson submitted it.

Friends Provident obtained a report from her consultant neurologist, who confirmed an unequivocal diagnosis of MS. A request was then made to her GP for sight of her medical records.

In his judgment yesterday, Lord Eassie said: "The letter referred to the notes being required to help [the firm’s] chief medical officer in the assessment of the claim and stated that they would be given ‘careful and sympathetic consideration’.

“However … [the firm] had already obtained all the information they required to satisfy themselves that [Ms Cuthbertson] had multiple sclerosis, and the only purpose of recovering the GP records was to see whether … there was any entry which might give grounds for avoiding or invalidating the policy under which the claim was being made.”

Friends Provident did reject the claim on the ground that Ms Cuthbertson had failed to disclose her full medical history.
In its defences, Friends Provident cited five consultations with the GP which, it claimed, ought to have been disclosed. Those took place between 1990 and 1994 and involved complaints about eye pain, an ear problem and tingling in a leg.

Ms Cuthbertson’s neurologist said that, with the benefit of hindsight, and knowing her now to have MS, it might be possible “to discern in some of the entries a possible indication that she was developing the unfortunate disorder”. However, he would not have expected a GP to have been alerted to the possible significance of the incidents.
Lord Eassie said: “I am satisfied that, at the time of answering the matters raised in the application forms, she did not think that the consultations with her GP were of any materiality.”

Source: The Scotsman ©2006 Scotsman.com

Although it is not precedence in the UK because of EU laws a judge will take this into consideration.

This ‘deferral period’ is probably referring to your claim time. I seem to remember a person who’s Insurance Company would not pay him as there is a difference in getting your CI through your work or privately. Through your work have I believe a 2 year period before you can claim; I may be wrong on this.

Also see http://www.thisismoney.co.uk/money/news/article-2287035/Financial-Mail-wins-280k-payout-MS-sufferer-spent-3-years-battling-L-G.html

This means it’s a precedent in England.

George

As Carol says; ask the DLS if they would assist Multiple Sclerosis Legal Advice Line | Disability Law Service

You will need to find a solicitor who works in that field to fight your corner they know what to do ,

I had similar when I was diagnosed with lupus nearly 20 years ago when I told insurer as the policy said two inspectors came out said I should never been accepted for critical cover because I had dangerous occupation I found good solicitor he got me

Good compensation .

Or there is the insurance ombudsman .good luck

Thank you all for your help and advice. I shall move forward with my appeal. Fingers crossed!

Hi Natalie

Just wondering how you got on. I am in almost exactly the same situation and have just had my claim refused.

I had one episode of numbness, which went away and they have said this is a pre-existing condition.

Any advice would be much appreciated.

Thanks!

Did you both declare that you’d had these symptoms when you took the critical illness cover out?

As it’s a group policy through an employer there is no declaration. I clicked a button on an intranet site to say I wanted to join. That’s it.