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Critical Illnessclaim with Legal and General

Hi all, I really need some advice and emotional support at the moment.

My diagnosis was confirmed on 19th January of this year. It was only when my ms nurse visited me at home for the first time that I was made aware that ms is covered under most critical llness policies which we have. She visited me on the 16th of April and I said to my husband to go and fetch our documents from the breifcase in the loft as the policies were taken out 12 years ago. He didn’t do this untill the Friday night - and i never read them until 10pm at night. Then I realised that I had to confirm in writing within 3 months of dx and L and G are shut weekends!!! So, we drove to Hove in Brighton from Portsmouth that night with a hand written letter to the security guard - phew!

I phoned last week and they said that they had received details from my gp and neuro as requested. I re-phoned today and was told they have written to my gp again with regards to an episode 11 years ago (we have had our policies 10 years). I was going to Greece on holiday with the family but became ill before I flew, sickness, dizzyness and pins and needles in my legs. visited the Gp (who is no longer there) and he said I was okay to fly and it was probably a virus. When out in Greece I was “laid up” for a couple of days and greek doctor visited me who gave me a jab in my bum - I assume it was pethadene and I was fine and enjoyed the rest of the holiday. I visited the gp on return just to say what the greek doctor did.

No repeat symptoms etc and the pins and needles are nothing like in feeling or relation to what I have with my Ms - totally different. Anyway I first saw my neuro in July last year and he asked if I had any sensory symptoms and I said no. Obviously from July to seeing him again in January this came back in my mind so I mentioned it and asked could it be related (not knowing about the critical claim at the time) and he said “who knows”. This was obviously logged in his notes that he sent back to L and G. He has since retired. So, on conversation today with them, they said that my neuro has said 11 years ago i couldn’t move for 2 days and had pins and needles so they have requested more info from the gp. I phoned the gp who said "They have requested info about this episode but there is nothing on your records! It shows that you saw the gp at the time for a consultation and it mentions your glue ear hence the vomiting and dizziness but the record is blank! no entry. Then it says you hada consultation with the nurse but again nothing is recorded!!! All I can reply back to L and G is that you had glue ear hence the dizziness, vomiting, you were okay to fly to greece and the pins and needles were probably glue ear/infection related. At no point is there any mention that you could not move!!

So, my neuro (now retired) has obviously misheard me saying I was laid up not “unable to move” as he has recorded it, and my mum is a witness as she was with me when I saw him.

I have no medical records for the time of this episode other than glue ear and pins and needles in legs which i was told at the time was either viral or trapped nerve and the same said to me from the greek doctor - again this is not on my records either

Help! will they pay out? my gp can’t make up records that don’t exist and he has said i have never had any related condition and i agree and he has re said this on the reply.

What about my retired neuro? his notes are incorrect saying i couldn’t move when i had said i was “laid up”

Help please!!

I had a policy with Legal and General but I’m afraid it was bad news for me, they said that because I had an episode of retinal vasculitis in the first two years of the policy they wouldn;t pay out. We are now trying to clam for my wife’s fibromyalgia from Legal and General but we’re using a no-win no-fee solicitor who has been successful with my wife’s other critical illness policy through Halifax.

you have pm

Hi I had a policy with L &G and made my claim feb 2010. They refused me for non disclosure. I took my case to the FOS. After 3 years of fighting the ombudsman finally found in my favour. My story has been mentioned a few times on this site and this the first time I have written anything on this board even though I have been a member since 2010. What I will say is, don’t give up. That’s what they want!!! You will see my story in the mail on Sunday from a few months ago around feb or march. Should find it by using my full name Mark Cannon. The story which was featured in the papers was only half the story.

Thanks Mark. I am really stressed over this and they haven’t even given me an outcome yet! On the plus side I have a friend who used to deal in insuranxe and mortgages. She looked at my documents today and saw that I had xrirical illness cover in 1999 which was 3 years prior to the dizzyness,puns and needles. It was only in 2002 when we had additional borrowing on the mortgage that the cover was increased to cover the amount. She says I was insured under the old policy at the time and the new policy would have just been set up to cover the amount increased. I could swear at the time the information from the then running policy was just ported over. We have never had copies of what was asked or documented. Hopefully this will help if I need it. I just hope they pay out without fuss when they get my gp report

Hi Dottydoo,

If you read these two articles below both state quiet clearly if nobody has said to you ‘It could be MS’ how are you to know? Forgetting to mention appointments with doctor you did not feel was relevant that happened 10 years ago any judge would surely understand.

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 http://www.thisismoney.co.uk/money/news/article-2287035/Financial-Mail-wins-280k-payout-MS-sufferer-spent-3-years-battling-L-G.html

This means it’s a precedent in England.

George

I am pleased to say I had Critical illness cover with the Legal and General and the did pay up!!! Al though I had had MS Symptoms about 20 years before the cover was taken out. over 3 years after taking the cover and the birth of our daughter then wham!! MS diagnosed about 3 years later!

I do hope you get some result from Legal and General. Overall, I couldn’t fault them!

C x

Hi again It will depend on what they ask your GP in the report they will request from him. Sounds like your first policy from 1999 should be ok. Wait and see what they come back with. If they are told by the doctor of what you have mentioned they may come back saying the second policy was void due to non disclosure. You can appeal that decision and if still not successful you go down the route I went. I will keep checking the posts to see how you get on. What I will also say it was the most stressful 3 years of my life and I have got a lot to thank my wife for for getting me through it !!! Good luck!

Thanks everyone. I phoned today, the doctor’s report is in but my assessor hasn’t had time to look at it yet so was told by another “You are lookibg at the end of next week now but hopefully we shall have some good news for you”. My assessor was yet again away from his desk. Fingers crossed, I will update as soon as I know xx

Hi dd,

I do hope all turns out ok. Im awaiting dx, been told probable. With L&G too so will be waiting on your outcome. Ive been wracking brains but can only think of ear infections, wax, heart trouble (made aware of) etc nothing ms related. What makes me mad is if a gp doesnt say this is suspicious ill refer your for ms…how are us suposse to know what may be significant years later, or even remember!

feeling happy and more reassured candystripe had no problem . I only have small mortgage for someone my age but hoping reduce ours to help the symptoms/mobility issues, mortgage dissapearing would help, after all why do we bother paying insurance?!!

hope you get an answer soon dd.

kel x

Also, just googled nationwide (who our original policies were taken out with) now under legal and general, and the question relating to pins and needles asks: have you visited the doctor or sought advice for persistant pins and needles" well I can categorically say “no” as I would have done on the application as a one off for a day or 2 is not persistant and I have not had it since. I am praying hard for good news xx

Thankyou Kel, I will keep you posted. Xx

Hi all, just thought I would update you all: No news yet. As said before my gp report was on on 11th June and I have heard nothing since. Is this good or bad? Surely if they were going to turn me down they would have done by now? I know these large companies have hundreds of claims going on. I can’t stress for much longer. My leg is tight. It hurts when anything rubs over it, bedding,trousers etc like my skin has been burnt off. I think I am having a relapse and it’s due to this. I will keep you updated Dawn x

Dawn i think my claim took about 6 weeks from start to finish. Dont let yourself get worked up over it. i know its hard not to and i do hope you get the right result.

atb MTT

Hi dottydoo It took L&G 9 months to say the weren’t accepting my claim. About 5 months of that they were trying to get the to the bottom of the non disclosure. This was because an intermediary was involved. But to be fair to L&G they did keep me upto date with what was going on by letter and telephone. Keep you’re chin up and as MTT says dont let it get you worked up! Mark

Well I couldn’t wait any longer being in limbo so I phoned L and G tonight. Yet again my assessor had left for the day but I was told my claim was now with the underwriters and this is normal practice and they hope to hear in the next couple of days. So we will see! I have my 1999 policy to hand with the continuous cover option to hand if I need to fight which states: the continuation option will be included in this plan unless specifically excluded on the schedule. You may use this option to effect additional life cover if you have a mortgage outstanding at the end of the plan term. The additional life cover will be effected by a new plan without the need for evidence of the health of the life covered. Other underwriting requirements such as insuravle interes and financial assessment must still be met. So, in reality as said before my 2002 policy was set up from the 1999 one to cover the additional borrowing on the mortgage. The pins and needles I mentioned to my neuro was in 2001. They are obviously looking at the 2002 policy and non disclosure from 2001. But this surely can’t be taken into account from the statement above. I am prepared to fight if need be but obviously I need their decision first and may be fretting over nothing. I have not mentioned the 1999 policy to them. That is my secret weapon! Will keep you posted. Dawn x

Hi Try not to worry too much I think it sounds positive. These things can take a while to sort out. I went through a similar thing with a life insurance claim. If (and hopefully they won’t) they refuse to pay it is so worth fighting when you have a good claim. Insurance companies often do anything to avoid paying a claim and rely on people just accepting their decision. The financial omnubson service is really excellent if you need it. Very good luck Bea

I phoned Legal and General again today as 3 days have now passes so I thought they must have heard from the underwiters by now. As per usual my assessor had left for the day (agaon) this was 4.30pm. But I was told…MY CLAIM IS BEING PAID!!! 2 letters wete posted to me today. I can’t believe it. I can’t stop crying. I was also told my assessor was naughty and should have phoned me today. But I don’t care now. Thankyou to everyone for r your support. These 3 months have been hell xxxx Dawn xx

Yay you.

That’s fantastic news. Well done for all your hard work and perseverance.

Angela x

Thanks Angela hun xx