Critical illness decline

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!

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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

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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.

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The clause was that I had previous symptoms whether diagnosed or not means claim can’t 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?

I’m 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.

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Group policies are a blessing for those of us with pre-existing conditions that we didn’t 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 didn’t disclose fully, then that’s 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.

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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?

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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 :face_with_spiral_eyes:

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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 “possible MS”, 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 don’t ask, you don’t get. Good luck.

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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

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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.

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