Hi all,
I need some guidance if possible.
I was diagnosed with RRMS in December 2023. It was suggested that as I have critical illness cover that I could look to claim
They have come back to me today as said that as the consultant feels that symptoms I had from 2009 could have been the start of MS then the claim would be declined. Even though no evidence to support this
Do you think I should appeal or is it a lost cause?
Any advice I would appreciate greatly
Thanks
They are trying it on. Your diagnosis is very recent. Prior to that you were undiagnosed. YOU are the one with evidence to support the timeline.
Go for it!
It will probably depend on when investigations started. If you had no idea there was a problem when the cover was taken out then they should pay up. However if you had an indication of a problem before the cover was initiated then they have reason to decline.
Timing is everything
I would be inclined to press on with your claim. The worst that can happen is that no remains no. The best that can happen is they pay out. To me that sounds worth going for.
The clause was that I had previous symptoms whether diagnosed or not means claim canât be paid out. I have raised a complaint (not sure whether pointless) but feel that how could I of know that this would have been MS when the consultant and GP at the time had no concerns?
Iâm struggling on what to do next as I feel that it was an easy way out as all this was out of my control. With the policy through work there is no questionnaire to state any illnesses previously that should be noted.
Group policies are a blessing for those of us with pre-existing conditions that we didnât know we had.
For individual policies, I thought you would typically be covered for anything included in your cover that happened subsequently, assuming you had answered all their questions fully and to the best of your knowledge when applying and they accepted you on that basis. If what they are saying is that you didnât disclose fully, then thatâs a separate argument to have with them. In that case surely they need to tell you where they think you went wrong and give you a chance to defend yourself.
Definitely pursue it. You have not one but two medical professionals who saw you but could not make a diagnosis. Where does it end? A headache turns into a brain tumour?
We all have aches & pains. I put up with them for years, even had a (mis)diagnosis. I was looking into increasing life insurance and procrastinated. Then got my MS diagnosis and became uninsurable. Do they want it both ways?
Thats the thing, there was nothing i had to confirm when taking it out. Ive had the policy for over 10 years now! Just dont understand it 
Hello. Accessing your complete medical file online can give you a clue about what happened. If at any point, before the exact date you took the insurance, the file refers to âpossible MSâ, that would be a problem. I had migraines and another issue with my eye (drusen) before developing Optic Neuritis and eventually getting the MS diagnosis. The migraines and drusen did not stop me from winning the claim, as I had listed them in the questionnaire, and nowhere in my file there was a note of possible MS. So, my opinion is, please access your file to read the language of the doctors, and then fight for it. Go to the ombudsman if necessarily. If you donât ask, you donât get. Good luck.
Thank you. Yeah i have got medical records and nothing ever mention MS. As work benefit never had to give them previous information and i think i had policy before the checks in 2009. I will wait and see what they say from complaint and definitely will be taking it further
Then you must definitely chase and complain. You are not supposed to know if you have MS, and to report to anyone, unless somebody had told you before you started your policy. Meanwhile, a good idea would be to make sure you get everything in writing. You will need a reason for the decline, and if you choose to take this case further, having everything in writing will help. Wishing you luck.
Hi, I âretiredâ from being a classroom assistant [ children with multiple disabilities] about 30 yrs ago. I had âsymptomsâ ,but no one told me what the symptoms were of, even though the medical profession knew/suspected. I fell down in classroom, & could not get get up. Another classroom assistant took me home. Eventually medical profession told me what they suspected. I managed another 18 months before same thing happed, & that was it. I actually got no help from my union [Unison - they just made me a life member, no more subs to pay? ] but NCC were more helpful. So helpful that they almost made me take retirement om âmedicalâ grounds? as far as the critical illness cover being declined, at that time you had no idea of what it was that you had, if anything, just a series of seemingly unrelated symptoms, you are not a medical professional, if they do not tell you, there is no reason why you would know, i feel that you should appeal. After all if you had been having migraines a lot, do you immediately think you have a brain tumour, & demand to see a specialist?
If all else fails, talk to one of those âambulance chasingâ, no-win-no-fee lawyers. Theyâll want a chunk of your award but at least youâll get the rest.
Mine paid me quite a lot of money. Take the case publicly on social media and appeal.
Hi
I had critical illness cover on my mortgage. I tried to claim when diagnosed with ppms. Declined as I âwasnât sick enoughâ but forced to medically retire. I wrote to the Financial Ombudsman as I was on the brink of losing everything. They made them pay out and a year later I was surprised when i received a cheque in the post. They had been forced to pay me ÂŁ900 compensaton for the stress theyâd caused.
I hope this helps, itâs worth trying. Good luck.
Cath