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Critical illness insurance again

First a little bit of back story: On starting my last job in 2009 I was already diagnosed with MS, but with no major symptoms at the time. To the observer they probably wouldn’t have been aware that I had MS. However I thought that if I ended up with diagnosis of something else such as cancer at a later date it would be very bad my family. I therefore entered into my employer’s critical illness insurance for me and my wife. This was fully understanding that my diagnosis of MS was an existing condition and I could not claim for it.

Since then I have suffered significant disability; loss of a lot of my independence; total paralysis in my right leg and I had to implement many home adaptions for washing and getting in and out of bed. I have stopped work due to this, but I’m still on the policy incase the worst happens. I feel that l would qualify for some other issues on the policy, such as loss of independent existence; paralysis of limbs and total and permanent disability. These have all occurred after I took out the policy but what caused by existing condition, so I’m unsure whether they are valid for claiming or not.

I’m going to ring the insurer to clarify situation since the documentation I can find is unclear, it looks like a claim might be sucessful since I can find nothing on linked conditions. But has anyone made a claim under this type of situation before? If so were you successful?

hi reddevilade

it is very unlikely that they will pay out because as you say it was an existing condition.

insurance companies are very tough on these things.

so sorry.

by the way your user name indicates a football supporter, not man utd by any chance?

my whole family support utd.

carole x

Good idea to ask them - you might as well - but I’m afraid that I agree with Carole that your chances don’t sound great. But at least you can clarify what you are and are not covered for, so you know what you’re paying for.

Alison

p.s. I do regret the moment when I said ‘no thanks’ when they asked whether I wanted critical illness as well as life cover on the mortgage, back in the days when I was insurable! I am always sad to see posts from undiagnosed people over on the Limboland board asking whether it is already too late to get critical illness cover for anything remotely neurological - which it is, of course. :frowning:

Afraid not (have been asked this before :slight_smile: as I use the username elsewhere). The name reflects that I hare a firey mane of red hair. Not really into football myself.

Thanks for the answers guys, K suspect it’s a no go too, but my legal hat says that if the policy is worded as it seems to be I may be able to corner them into paying since the conditions are distinct from MS diagnosis even if they are caused by MS. I’ll seek some legal clarification from a solicitor if the just brush me off without illustrating why the claim would be invalid in the policy terms (I think I’ve missed something there). I’ll update as I go.

one thing I did find out from being a senior manager at a company is that company group policies can help here. I gained income protection insurance through a company core (this is important - everyone needs to receive it, it can’t be an opt-in benefit) benefit. I was told by the company solicitor that in this situation it is illegal for an insurance provider to exclude existing conditions, they are insuring a group of people and excluding people as they are disabled from that group is disability discrimination under the law as it stands. So I was entered into the policy post diagnosis and was able to successfully claim once I became too ill to work, the policy pays 2/3 or my old salary 'till 65 so I don’t need to dip into the pension early. Harder to claim than critical illness, but much more valuable in your younger years (I’m only 36 myself).

My advice to any newly diagnosed person is check if their employer has such a policy in place, if so check the conditions for claiming and keep this in mind when considering other jobs, if not try to convince them to take one out and if that fails think about this when considering other jobs, do they offer this benefit it can give enormous peace of mind.

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That’s really useful advice; those company/group policies (and pension schemes) where the individual’s risks are absorbed into the whole are brilliant for people who are (ahem!) more risky than the average. I am glad that it worked out so well for you. When there’s quite a lot going wrong in life, it is very nice when something goes right!

Alison

Sorry to be so blunt but I wouldn’t even waste a phone call on it. The insurer is not going to pay out on issues directly caused by an illness specifically excluded on the policy.

That’s definitely not true. Reading through the policy it does state the they will not pay out on a criteria that has resulted from a related existing within the first two years, but after that the exclusion no longer applies. This is their related conditions exclusion policy, specifically addressing this point. That does sound to me that, as I am past the two years and was not suffering the issued I mentioned above at that point, I am only excluded for diagnosis of MS as that was done at the time of starting on the policy. Further disability from the MS that fits their included conditions should be claimable. It’s definitely worth a phone call, in my opinion, to clear this up.

If I am successful iI think I’ll contact the MS Society to see if we can get their finance guides improved to explain this stuff better as I feel like I’m going into unexplored territory here. They make no reference to the group policies which I mention above from what I can see, and if I’m right here then the common view that post diagnosis you are uninsurable could do with some revision.

In fairness, you didn’t explain any of that small print in any of your posts. I still don’t think you’ll be successful but good luck to you if you choose to pursue it.

Yes sorry I didn’t do that, I was originally wondering if anyone had taken this avenue and been successful so I felt the specific details of my policy weren’t relevant to other people’s experiences.

Sorry again I was blunt back, it’s a pet peeve of mine where people base an argument on something they’ve made up and present as a fact (many, many older members of my family do this presenting their incorrect made up “facts” as experience to try and control what you are doing, so it gets my goat when I see it - blame my parents and in-laws :slight_smile: not me). You presented the insurance company not being interested as an industry wise thing when I could already see that wasn’t the case with mine and several other policies online wich have their terms online having this related condition section.

I can’t see myself being successful too to be honest, but the policy seems to be worded such that I should be and I also felt the same way about the income protection insurance I mentioned earlier, but that was successful. The more I read the policy the more I feel I’d be a fool not to follow up, I after all have nothing to lose but my free time, which due to my disability levels now is not as valuable as it once was.

No worries. Now you’ve given the extra information, I can see where you’re coming from. I just know what insurers are like. Whilst I don’t work specifically in industry, I do have some knowledge and I know there is nothing they hate more than paying out!

I’d be interested to know how it works out for you. Good luck!

Ok before I call them I think I’ve found the small print that will stop me dead in my tracks. Loss of independent existence; paralysis of limbs and total and permanent disability are specifically stated to not be claimable if due to an existing condition in an additional clause buried in the small print, since this wording is more specific than the related condition policy (which is more of a general thing) I expect it will take preference over it when interpreting the contract. Hopefully I’ll get a chance to call them next week, but this has deflated any expectations I had to negligible levels.

i’m sorry that i have nothing useful to add, only wanted to say, that the older i get the surer and surer i am that all insurance policies are typed somewhere VERY hot, by someone with horns!

wendy x

Thought so. To be honest, if it could be interpreted the way you’d hoped, the reality would be that nobody with MS, or any progressive disease, would ever get cover in the first place.

A worthwhile exception that has been pointed out would be if an employer provided blanket cover to everyone (i.e. it’s not an “opt-in” system). In that case, it does make sense it would be discriminatory for an individual with MS not to receive the cover all their colleagues get routinely. But when it’s on an individual “opt-in” basis, they’re covering the person, not a group, so they’re entitled to personalise the policy to reflect individual risk - including barring some things altogether.

I would think the blanket policies are quite rare - especially these days, as job-related perks get stingier and stingier. My employer certainly offered insurance to everyone, but you didn’t have to take it, so you had no grievance if your policy had exclusions your neighbour’s didn’t (but theirs might have some yours didn’t).

Tina

I am sorry to hear that.

However, your good point still stands about group/company policies being an excellent thing when a person has joined them before getting into neurological trouble. And the importance of a person checking carefully that they don’t have such cover before considering changing employers; such cover is of immense value to an MSer and, as sad experience seems to be showing (alas), is unobtainable once a person has MS or even look as though they might have MS.

So thanks for raising it on here - you might well have helped others in a very important way.

Alison

Yeah, that of course makes sense and this wasn’t why I took out the insurance in the first place so it’s not that devastating (I was thinking of later getting cancer or having a heart attack beyond the MS when I took it out). It is very weird of this related condition front, it’s just the ones I mentioned that seemed to be excluded from it. For example if you have prior MS and later lose the ability to speak, become deaf or blind then you can claim, but loss of independence, total disability or limb paralysis (which I thought I had up turns out it’s a relapse I’m currently having as steroids have cleared it up - these all need to be permanent) is a no go from the looks of thngs.

I think the spirit of this clause would be for something like diabetes, such that you need to have a limb amputated years into the policy you can claim, just not in the first two years (i.e. you can’t take out the policy knowing you’ll be qualifying soon due to the state of your illness).

Yeah, now knowing (and taking advantage) of this for income protection makes me annoyed that this information isn’t disseminated better to people upon diagnosis, I’ve been afforded a lot of luck that others were denied (and equally deserved).

I think the same issue also applies to a lesser degree to company opt-in policies in that although the can excluded existing conditions, they cannot refuse to insure you, again would be disability discrimination since it’s a benefit available to all employees.

If they ever start privatising the NHS (god forbid) these exclusions and chronic condition clauses have to be made illegal in health insurance policies IMO for it to work properly.

Again, I would really like to see if we as a community (or the MS Society) can put together a list of employers offering these benefits with info such as when the information was known to be accurate, if it’s a core or opt-in benefit, who the policy is with, if a claim has been successful through them and how disabled the claimer was as a guide. It would help people knowing who to seek out. Are there any legal issues publishing this info (why I’d want the MS Society involved). I can give two employers to start the list (although the one I claimed with for income protection is pretty hard to get employed with).

This may not be a lost cause, but we’ll see - my expectations are low. In my previous post I said I’d like to get this information better published by the MS Society with the facts and a guide of how to take advantage of these schemes, I think I’ll call them in the coming to discuss it.

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So spoke to the insurers and my interpretation of the policy is spot on according to them. Cannot claim for pre-existing diagnosis, can claim for new issue caused by pre-existing condition if not within 2 years of joining policy but with the exception of total disability, paralysis of limbs or loss of independence which cannot be claimed when caused by a pre-exiting condition. Loss of speech/sight/hearing are fair game though. I personally cannot claim but others could under these terms, unfortunately it sounds like talking to them that this isn’t standard on these policies and it’s common for a blanket ban of stuff caused by existing conditions in critical insurance policies as people have said. So I guess check the precise conditions is the lesson.

Not the end of the world as this wasn’t the reason I entered the policy, I will follow up with the MS Society during the week to see if their Insurance booklet can be improved on the employer benefit front.

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Spoke to the MS Society, and sounds like they will be adding the information I put in this thread above regarding employer group policies in their Insurance booklet when they next update it. Won’t be rewritten until next year but I’m glad to have that result.

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