Hi, not sure if anyone out there can help. I was diagnosed earlier this year. I have minimal symptoms at present only suffering L’hermitte’s sign and some occasional mild bladder problems. I have yet to be assessed whether I have any cognitive impairment or if my poor memory is simply a sign of getting older. I have critical illness cover which I took out in 1996. It clearly states that Ms is covered as long as there is “continuous clinical impairment of motor or sensory function lasting at least 3 months”. I am unsure whether this would cover my situation. On the one hand there must be some impairment to cause the tingling sensation in my spine. On the other hand it doesn’t stop me doing anything. I have tried to find a definition of these terms but am drawing a blank. I am worried that if I make a claim that is rejected then they will reassess my premiums and put them up so high I can no longer afford to make payment (or am I being cynical). I would like to be able to make a claim whilst I am still well so I can invest the money or alternatively just enjoy it while I can. Does anyone out there have any experience of making a claim? Any help would be appreciated.
Hiya,
I think you will find they cannot put up your premiums because of your diagnosis.
I suggest you contact the Disabled Law Service for confirmation; http://dls.org.uk/.
This is a free service paid for by the MS Society and like any solicitor is only privy between you and them.
If I am right claim; they can then sort out when and if you should be paid.
George
Brilliant. Thanks. I did actually call them today without giving my details and asked them the hypothetical question. Think I’ll give it a go.
my lovely kath (RIP) was an expert in welfare law.
she assured me that ms being a chronic condition does count as a disability.
check it though cos i have ms holes in my brain
I’m only telling you this as they usually use every tactic to get out of paying and don’t want you frightened off from getting what you rightly deserve.
Just in case they get a doctor’s appointment report that says you had a cold in 1991 that you did not report to us. This was obviously the start of your MS; these newspaper cuttings are precedence in Law so they cannot do that.
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 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.
Also see Financial Mail wins £280k payout for MS sufferer who spent 3 years battling L&G | This is Money
This means it’s a precedent in England.
George
Thank you. Hope I won’t be in that position as my policy was taken out so long ago but like you say they use every trick in the book. I’ve messaged my ms nurse for her view on whether my Neurologist would consider I fulfil the criteria at out too. She may not be able to help but it’s worth an ask. x
Update I get to see the Neurologist’s report tomorrow so that should give me some idea whether I am likely to be successful. It’s been a long wait. Going on holiday in 3 weeks and I’d really hoped to know by then but not looking likely now although they did say they have 5 working days after medical reports are received to make their decision so fingers crossed
Hi Newbie, if its any help, I had critical illness cover in taken out in 2004. I had forgotten about it & was contacted in 2009 to inform me the company I originally took it out with had been taken over & was I happy with it, etc, etc. Anyway I telephone them & asked if MS was covered ( I was diagnosed 2005) as MS is a condition that will either progress or stay the same it is regarded as a critical illness I was told & it was listed in the top 3 as critical along with Cancer & Parkinsons. I applied & it was paid out. They write to your specialist requesting proof, but the diagnosis is as it is. As you were diagnosed after you took it out, you should have no problem. You Will only have 1 payment depending on how much you covered originally was covered for & obviously, you wont carry on paying the premiums. There is no reason you will get higher premiums as the payout cancels the policy. I was paid within 8 weeks. You dont need to provide evidence for progression as the diagnosis is enough. Apparently, MS is automatically included in most, if not all policies, my friend’s just confirmed it, as shes a financial adviser!!! Go for it, no point paying premiums if their are not going to pay out on this, her words not mine!! ( shes having a coffee with me as I’m writing this!! Good luck, let us know how you get on, phone them asap!! Tracey x
Thanks for your response. I have made a claim. Got the report now and I’m annoyed as the insurance company seem to have added an additional criteria that they require evidence of loss of neurological function compatible with the neurological deficit seen. My neuro points to migraines and my report of memory problems. I am worried that as I’ve had migraines since my teens that they will try to wriggle out of it but my understanding was that there is no proven link. Also my memory is being assessed and I think i did really well on the tests as my problems are more multi tasking type problems and distractions. Not got the results of that yet. I am worried this will hold up/cause them to reject my claim. I think it’s really sneaky to add in another criteria without me knowing which I only found out about because I asked to see the Neurologist report first. If it gets rejected I will still keep the policy as my neuro function etc may deteriorate meaning a second claim may succeed.
Crafty buggers. My friend has asked when were you diagnosed & what with eg RRMS & are you on DMDS? the migraines should not come into it, they want to know if about whether you are suffering movement problems & numbness for example. Tracey x
I was diagnosed in July 2016 with RRMS and I am on Copaxone 3xpw. I don’t have numbness but I do get buzzing in my spine when I bend my head and have done so for about a year. I was thinking that this was probably the strongest point on which to base my claim in any event so I’ve been a bit thrown my the reference to migraines and memory problems really.
If you were experiencing symptoms (obviously) before diagnosis & you are having trouble with sensations in your spine, this will have an effect on your motor & sensory functions, The neurologist will back this up. Are these symptoms what you presented with which lead to the investigations & diagnosis in the 1st place? Tracey x
I rang the Neurologist and spoke to her secretary querying why when answering questions about neuro symptoms she doesn’t mention the tingling in my spine and she referred me to the question about me initial symptoms that I had buzzing sensation in my spine for 6 weeks. It did stop but that was prior to my diagnosis and I have had it constantly since then and would have said so when I met her for my diagnosis so I’m a bit upset and worried she doesn’t know that. I have asked her to consider changing the report. My husband also remembers me speaking about it and asking if the meds would stop the tingling. She also refers to a normal neurological examination on 2nd August but I didn’t have an appointment on that date. I saw her on 25th July - not a date I’ll ever forget - how can she say normal neuro exam when I’m still having symptoms. So glad I opted to see the report now.
Normal neurological examination!!! You have MS! You will never have normal neurological again! Stupid woman, (not you!). Shes the consultant you are under? Do you see her often? Sorry so many questions, but I cant believe that someone that is supposed to be well up on MS & looking after you honestly thinks you wont be experiencing some forms of motor & sensory problems. She has very bad info keeping skills as well, like you & all of us on here, the date we were diagnosed will be etched in our brain for ever, I can even remember the time the news was passed on!! She sounds a right turnip ( not being allowed a different word)!, can you approach your Dr? Worth a try, get them to liase with her, you are entitled to your claim, cant believe shes such a t*t! She must have your notes on when you were 1st diagnosed & the follow up treatment you have received since, penny to a pound she must have detailled the initial diagnosis & course of action.Dont give up you are entitled to your medical information, my consultant just stated yes I had MS, it wasnt going to improve & caused me such & such problems & I was on blah,blah meds. Good luck let me know how you do Tracey x
Thanks I will. I asked why she put normal neuro exam and was told it was about my reflexes etc. Just feels like every turn there is some problem or another. Thanks so much for your responses good to know someone out there who can relate and see the issues we have to deal with every day. Family and friends have been great but nothing quite like having gone through it yourself to really get how important these little details can be x
You take care, pretty sure it will work out, reflexes dont really relate to loss of feeling in fingers etc though does it? Anyway all the best, have a good holiday & I hope to hear from you very soon with good news! Tracey x
I’ve emailed her setting out the things I feel need changing. I just can’t believe she can get it so wrong. Starting to question what I told her now.
Update, after getting the Neurologist to change her report to include the lhermitte’s sign I still felt the report was unhelpful but hoped that it would at least meant I could appeal to the Ombudsman. After scrapping together enough money to go on a family holiday, I returned yesterday to the brilliant news that they have accepted my claim and the money is in my bank today. Absolutely amazing. Will mean I’m mortgage free with a nice little nest egg. Potentially going to change jobs as mine is very stressful. Feel like I now have real options. Thanks to all who took the time to help me and to anyone with Critical Illness Insurance all I can say is make a claim no matter how minimal it is affecting you.