I know I should have let this go but it’s about to resurface again when I was diagnosed with ms back in 2001 I put in a claim to have my mortgage paid off due to a critical illness. The insurance company refused to pay out because I hadn’t declared I had had opticneuritis way back in the 80s (didn’t know this is one of the first symptoms of ms) and 1 bout of depression. I have had to extend my mortgage and have been asked if want critical illness cover again. Any thoughts on whether it’s worth paying up again.
No if you have been diagnosed the company will not pay out CI; in fact if you have been diagnosed read this:
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
This means it’s a precedent in England so therefore your previous insurer should have paid; sue them…
You have the law on your side; contact http://www.financial-ombudsman.org.uk/consumer/complaints.htm and it will cost you nothing.
You must give your insurance company 8 weeks; if they still deny payment contact the Ombudsman.
I think there was someone on this site some time ago who had been dx’d with m.s. and this noted in his medical notes but he was never told he had m.s.
He had Critical illness cover taken out after this ‘secret’ dx and the company tried to get out of paying but he challenged them and won.
I should take advice from an insurance broker. On the face of it, it seems unlikely that critical illness cover would represent good value for you, given that the thing most likely to impinge on your earning capacity probably isn’t going to be covered. But you need to talk to the experts about your particular circumstances and needs. In my experience, getting reasonably-priced life cover for a mortgage is much less of a problem.
Whilst both of these stories are really good news can I just raise a couple of points of caution.
A decision by a Scottish court is NOT a precedent (ie binding) for courts in England and Wales - no more than a decision in the USA or Australia (and they have legal systems that are closer to the one in England than the Scottish one!)
What a decision in a different country CAN be is PERSUASIVE for a court looking for guidance when there is nothing else to go on. However they do not have to follow the other county’s decision.
George mentioned sueing the insurers if the company doesn’t change its decision. There are strict time limits for bringing court proceedings and in most cases you cannot start to sue somebody after more than 6 years.
The Insurance Ombudsman is not a Court and - although it has to follow certain legal rules - it might have different time limits which could be longer or could be shorter. You should take advice before taking any action.
Thanks everyone for the advice I’ve set the ball rolling by contacting citizens advice and emailing legal and general for copies of anything re my claim but not mentioned yet why I’ve asked for it. It’s nice to know there people out there supporting each other. Thanks again
Yes I will admit South Lanarkshire is in Scotland so this is not a precedent in England.
The Ombudsman however may look into and take action on any ruling you think unjustified Rule 2.8.2 within the Dispute Resolution (DISP) rules (found in the Financial Conduct Authority (FCA) Handbook) states that the Ombudsman cannot consider a complaint if it is made more than
- Six years after the event of; or (if later)
- Three years from the date on which the complainant became aware (or ought reasonable to have become aware) that he/she had cause for complaint.
That is why in my second email I said contact Ombudsman. You abide by rule (b) as you only became aware yesterday.
I was talking generally as too many people start shouting “sue 'em!!!” and it is not as straightforward as that.
All I was saying - as you have now said as well - is that A) Ombudsman is not a court, B) the Ombudsman has its own rules and time limits and C) people should get some advice before they start.
Dealing with the various Ombudsmen can be quite complicated and you have to get it right. It shouldn’t be but it is. I know because I won a complaint on behalf of my husband when there were a lot of people he knew in exactly the same position who didn’t win (a complaint against a bank who provided finance for what turned out to be a fraudulent training course)
I really hope that anyone who can take advantage of this decision can benefit from it. Insurers don’t like paying out