I was diagnosed with MS in 2010 and my policy would not Pay out for various reasons. With 2 small children I just couldnt bare the thought of taking on the insurance company feeling that they would just make any excuse anyway. Now that my oldest is in school I have the time to fight it. I have had various symptoms over the last few years but have never seen a neurologist since. I thought I could maybe keep a diary but would they somehow use the info to turn it around and say that I’m not entitled to the claim. Anyone have any ideas or advise on how to provide clear supporting evidence. I have an appointment with a neurologist again now because I feel I’m getting worse. Should I keep up the challenge of trying to get them to pay the policy or give up and live my life. I’m concerned I will have to reduce my hours in work soon and that’s why I’m looking into it all again!
Not sure if this helps but my insurance company would not do anything until they had confirmation from Neuro. Im PPMS and after Neuro confirmed diagnosis they asked him how he came to that decision!! It took a while but they eventually paid out. Good luck!
Hi Anon,
I was turned down on my first application for critical illness. At the time I was reading a John Grisham book about insurance claims. It was only fiction, I know, but the way the insurance companies denied legitimate claims made my blood boil so I banged my claim in again.
It was approved the second time round with no additional evidence.
Other than a letter from your neuro I’m not sure what they would want. My problem was that I was in limbo and didn’t have a clear dx at that time. (I did have a letter from my neuro saying that it couldn’t be anything else.) Under most policies just having MS is enough
Jane
My claim was accepted last year thankfully, and the criteria they used was that I must have had symptoms for a CONTINUOUS period of six months AND have had a firm diagnosis using techniques accepted at the time of claim (ie MRI and history). So, if you read your policy wording and it states the same (very likely if it was taken out in the last 10 years or so - I had two claims with two companies and the wording was identical!), then they haven’t really got a leg to stand on! Saying that, you have to have been 100% accurate with your original application as many companies try to use something as basic as a sniffle to avoid paying out! I used to be a financial adviser, so was lucky in that I knew the companies to avoid when I took out my policies 10 years ago! I only had to fill in a basic questionnaire for one policy, then both got reports from my neuro and GP. One was paid within 14 days, the other took three months! But they did pay and I’m (luckily) not even too bad at the moment. Good luck and fight hard!
Hi,
Most insurance companes lay down a period after diagnosis you must claim; say 6 months. Irrespective put in a claim now; they will contact whoever.
You are right to be apprehensive about your CI but as you can see from the article below you should be alright.
Insurance companies have a department named ‘How to wriggle out of claims’ and this is for future reference just in case. They may say something like ‘you had a cold in 1988, reported to the GP, this was obviously the start of your MS and you should have known.’
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 a 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.
Good luck, as you have done claim; suck it and see.
George
Thanks everyone for their comments! Much appreciated and I’ll keep trying then. Just need to decide now whether to open a new claim or appeal the existing one! Why so complicated! Not sure why I’m posting Anon, cause feel like I’m a money grabber!
I was told that, had my claim not been accepted first time, there was nothing to stop me trying again if things got worse. I suppose it depends on why they rejected it first time around! As for being a money grabber, you have paid for the policy, you’re entitled to claim. No one would question you claiming on your car insurance after an accident or on your home insurance after a burglary!
Just re read the posts and think from ggood post that I should appeal the existing claim. Fingers crossed!!! Thanks again.
Very true Emma!!! Lol!
The letter they sent me after I was diagnosed said Must meet macdonald criteria (which I presume I do otherwise wouldn’t be diagnosed.) Continuous for 6 months sensory or motor. (which it wasn’t at the time but is now) Must be by Diagnostic technique. MRI AND CSF. I’ve had MRI scans but I’m not keen on getting a lumbar puncture! They said and but surely if you meet the macdonald criteria you’d think it would cover it! Really want to reduce my hours in work. I’m not toooooo bad at the moment but fatigue is terrible!
Definitely claim…why were you initially turned down?? I got mine within 3 months of claiming…they requested neuro consultants report
If you didn’t meet the criteria before, but you do now, it’ll probably have to be a new claim. Just a thought! X
Rose- thinking the main reason is because it didn’t effect me continuously for 6 months. Emma- you’d think they should be able to tell me what to do! It’s just so strange. Funny I work in finance but still can’t figure it out. I’m afraid I’ll say 1 wrong thing and then not be able to reduce my hours!
Hope it all goes well when you claim again/fight the previous claim! It was a huge relief when mine paid up as, like you, I have young children (3 & nearly 5 years). It’s just one less thing to worry about. X
Mine are 3 and 5 too. So nice to chat to you as I’m sure some of your hard days are similar to mine! Lol! Can’t phone in sick to kids ; ) lol
I tell you what Hunny its a load of s***!!! Ive been fighting for 8 years!!! The b****** still oppose it!!! I should have had mortgage paid off!!! Royal Sun Alliance name & shame!!! Hope you not with these!!! Very best of luck babes be fighting till I die!!! Tracey xx
I know what you mean! Life goes on regardless when there’s little ones around! I have 3 free mornings a week now that one is at school and the other at nursery - I’m using them wisely to rest up and pace myself with housework etc. as I’m in the middle of a relapse at the moment (not major - just sensory problems with my leg and fatigue). Hubby is in charge of my eldest’s fifth birthday party tomorrow (only 35 children coming!!!) Tracey - that’s awful. Name and shame definitely! I know I was very lucky with mine, but that is beyond disgusting. X
That’s terrible Tracey! I’m not with them so fingers crossed!
35!!! Your braver than me. Lol Does everyone rest up when they have a relapse? Mine is mostly sensory and fatigue. I just keep going in a haze. Do you think not resting makes long you worse long term? I haven’t even seen a neurologist since being diagnosed. I just keep battling on. Only now my older child in school do I feel like I even have time to get some help! Lol
I rest because I know I’ll flag in the early afternoon just as the kids come home and I don’t want them to be affected (as much as possible). I don’t think it has long term effects though. I’m surprised you don’t have any follow ups - I would question that. In remission I’m pretty much ‘normal’, my worst relapse caused speech problems (like being drunk) and blurry eyes/double vision, but otherwise it’s mainly sensory. I’m booked to see my neuro once a year and alternating with my MS nurse once a year, so I basically see someone every six months. I can also call on my nurse or Physio whenever I need help! I assumed this was fairly standard? X