Declined critical illness claim

Finance and benefits
1

Please help

My husband has been declined a critical illness claim after a discovery of “non-disclosure” and have “avoided” the policy. We are utterly devastated by this news and wondering if anyone has any experience in appealing this. I have been on Financial Ombudsman site to gain advice and i do think we have a good right of appeal. However we are flabbergasted that we are in this position as we believe that the “non-disclosure” was completely innocent due to the wording and our understanding of the questions.

My husband had 2 episodes of “vertigo” which he saw the GP for one in 2009 and again 6 months later in 2010.

These episodes were when his head was tilted back when in a seated position (dentist chair) and it would spin for a few seconds before resolving. The GP said it was inner ear issue given exercises and no further follow up was required, and he never returned to the GP for this as it didn’t affect him. Which is why it then was forgotten on declaration 2.5yrs later when taking out premium. As on declaration it was asked if ever suffered from dizziness or loss of balance to which we answered no as effectively he didn’t, as he did not have balance or dizziness when standing or moving about.

Insurance company have said that if they had known about this then he would not of been offered insurance at all, as it was a clear indicator of MS which I don’t believe to be true.

They want to refund all premiums

We’ve begun the appeal with the insurance company themselves and now have to wait for their final decision before we can go to the FOS

I’d like some help and advice of how or who best to go to that could help get our point across,

  1. It never affected him daily, or even regularly enough for us to have remembered this symptom on taking out insurance

  2. His trade was such that he was forever climbing stairs and lifting so it never affected his balance nor dizziness when moving his head to standing

  3. Even if we had said yes to the declaration, on further questions I believe he would of been given insurance based on the GP saying it was a crystals in the inner ear and to do exercises and no further follow up as even with the second visit they said to do the exercises.

this is an extremely stressful and emotional situation and I don’t want to get the appeal wrong

Thank you in advance

2

Insurance are real buggers and will procrastinate till the cows come home. I think I am right in saying untill you have a decisive diagnosis, in a letter, from a neurologist, then you cannot be said to have MS. Not as far as the DWP and the likes of them are concerned anyway! So an insurance company - who aren’r medical professionals, cannot say “clear indication of MS”.

1 Like
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He was diagnosed with MS that’s not the issue, it’s help with fighting the decline of a critical insurance claim I need

4

Bit of a grey are in regards to symptoms of vertigo being tied in with MS. I’ve suffered nausea/dizziness for years, well before I was diagnosed with MS, my mother was the same so I just put it down to “being like mam”. These symptoms have got worse over the last 3 or 4 years, and definitely since being diagnosed with MS 6 years ago, but they were there for many years before actually being diagnosed with MS, yet every time I ask my MS clinic if these spells of “vertigo” could be linked to the MS they say no, however if you do a search online for MS & vertigo, theres a massive amount of info saying that dizzy spells and nausea is common amongst people with MS. My point in all of this is that it depends on who you ask, so if your insurance company seek medical advice from a neurologist that thinks there is a link with symptoms of vertigo/dizziness & MS, your fight for a valid claim could be a little harder, because their argument would/could be that in their medical experts opinion, your husband might of been showing signs of MS in 2009 & 2010 ? For what its worth I dont agree with that way of thinking, but knowing how these people work I’m just guessing they might go down that road ? It’s very difficult when we look back after being diagnosed and thinking, “maybe those little symptoms all those years ago might of been the very start of this disease”. I can certainly think of times now when I look back and see that I was showing odd symptoms years and years before I actually realised something was definitely wrong and then went to see my GP. You could ask your consultant what his opinion is on these “vertigo” symptoms and being linked to MS. I really do hope your claim is successful.

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I have vertigo it was not what diagnosed me with MS.

I do not get DIZZY with vertigo. dizzy and vertigo are not always the same.

Vertigo and dizziness, are symptoms rather than a disease. … Vertigo (a feeling of spinning or whirling when you are not actually moving). Unsteadiness (a sense of imbalance or staggering when standing or walking). Lightheadedness or feeling as if you are about to faint (presyncope)

Dizziness is the feeling of being lightheaded, woozy, or unbalanced. It affects the sensory organs, specifically the eyes and ears, so it can sometimes cause fainting.

To say that vertigo is a symptom of MS is bogus.

only 20 percent of people with MS may experience vertigo.

Many people with MS experience episodes of dizziness, which can make you feel lightheaded or off-balance. Some also have episodes of vertigo. ***(note that MS Trust is treating the TWO as SEPARATE ISSUES).

Vertigo is the false sensation of whirling or spinning of yourself or the world around you. According to one reportTrusted Source, about 20 percent of people with MS experience vertigo.

Vertigo is actually very common. Most of my family have had it at some point (non have MS), LOTS of my friends have had it too.

Causes of vertigo may include:

  • benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo

  • migraines – severe headaches

  • labyrinthitis – an inner ear infection

  • vestibular neuronitis – inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help to control balance

    NOTE ABOVE not one mention of MS.

One episode of vertigo is NOT a precursor to getting MS that is so bogus. My best friend has had vertigo all her life on and off and cant go in lifts she does not have MS.

Your husband may have been getting over a cold it is very common after a cold. 10 years ago you would hardly remember having a small incident of vertigo.

His GP said it was crystals in his inner ear so you need to get his notes hun for that period. ok.

these insurance people are disgusting. they will try anything to avoid paying out.

You have to stick to your guns.

You said:

As on declaration it was asked if ever suffered from dizziness or loss of balance to which we answered no as effectively he didn’t, as he did not have balance or dizziness when standing or moving about.

He did not suffer with balance or dizziness issues. I would go back to his GP and talk to him and say what is happening, and get the GP to write a letter to the effect that at the time he was not suffering with dizziness and balance problems as if he had been the GP may have diagnosed him differently if that makes sense. I think you need the GP on board with this.

and get his notes from 2009 and 2010 as I would assume it will back up the fact he did not present with dizziness or balance issues.

good luck. x

6

I assume there is a lot of money at stake here. If it were me I think I would be looking for professional advice from a lawyer specialising in this field. The insurer will be expert at defending their position and I would want to be giving them a strong professional challenge from the start. I am sure the lawyers associations would help you find someone suitable - or a google search might help you find someone near you. Initial consultations are usually free of charge. Very best wishes with your appeal

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I assume the Insurance Company got all your husbands medical notes. It’s not relevant that the vertigo didn’t impact on your husband’s work or that vertigo doesn’t necessarily mean m.s. is there. If the company have a policy of not insuring someone who has had vertigo then it’s going to be difficult for you. Perhaps your husband went to the doctor with a pain in his head/ear or a feeling of light headedness. Perhaps your husband didn’t use the terms dizziness or vertigo but it was the doctor who diagnosed him as having vertigo but crucially didn’t tell him that - just gave him some exercises to do. Read of someone who was denied C I C because he hadn’t disclosed he had been dx’d with m.s. He did this because the neuro didn’t tell him he had m.s. He appealed and won. Can your husband make a case for him not having been told he had dizziness or vertigo. The doctor wont remember every word that was said in the consultation. I wonder how the company would respond if they were told your husband was never told he had dizziness/vertigo. Importantly I’d get a professional to advise here - a solicitor?? - I would not contact the Insurance Co mysef

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Just as said they will try anything to get out of paying a claim. Please confirm with the Neurologisst the diagnosis. Most policies state you must show symptoms for 6 months. You probably qualify now but if not it’s only time. You may have to fight your corner; don’t give up; see below; different circumstances but just to show you must not take no for an answer. 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.

1 Like
9

With something as important as this I would speak to your neurologist, GP, and yes a solicitor that deals with this sort of thing.

Obviously you will always get “advice” on here from people with the best intentions, but experts we are NOT, and therefor can only speak from personal experience or advice that might of been given by our GP’s or consultants ect, which will vary considerably from person to person.

Unfortunately you will always find 2 people experiencing the exact same symptoms but having 2 totally different explanations given to them by their own GP’s/Consultants, it only takes one word or phrase explained to each one differently and thats what will stick in your head.

Again, Dr Google is great, but can be very misleading and sometimes not the best place to seek advice.

Type in dizzy spells in a Google search and theres a good chance that you’ve fallen prey to everything from too many Vodkas, a tumour, a gun shot to the head, or even having a good seeing too from a sex starved African elephant

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Thank you so much for this information. Do you have a source for this? This is exactly my thought process regarding the two and probably why we answered no to “dizziness” when the policy was taken out

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Hi MS trust, and some of the internet. i am sure if your husband had told your doctor he was dizzy he would have treated him differently like i said you need to see the medical notes you can buy them they are not expensive, and will give you the dates he was seen and why he went to see the GP. also i agree with the last poster i would find a lawyer who deals with this type of thing.

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This is very interesting thank you. I will definitely be using this example for the ombudsman complaint. I definitely feel they’ve searched his medical records to avoid and invalidate the policy.

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[quote=“Mumoftwo”]

This is very interesting thank you. I will definitely be using this example for the ombudsman complaint. I definitely feel they’ve searched his medical records to avoid and invalidate the policy.

[/quote] This is a complex issue and one that needs careful consideration about how to proceed I hope you take professional advice. Good luck.

14

My insurance under writers refused my claim though I had a definite diagnosis of MS, and it was a listed illness on the policy. Don’t let them bully you - go straight to the financial ombudsmen. I did and they were excellent, they contacted them and although it took them a couple of months, they paid out in full.

I’d been fighting with my insurance for so long that I almost lost my house as I’m a single parent and had no income as I was forced to retire and go on benefits as I couldn’t afford to take out a pension while working. Fortunately my parents were in a position that they could help or I’d be homeless. The FO made them compensate me too for the stress they’d caused and I got an extra 900 pounds. I was so relieved to be able to cover my bills and pay my parents back.

Any policy I take out now I check to make sure that they aren’t the under writers.

Stay strong, don’t let them bully you.

Cath x

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Mumoftwo, I don’t know if the Disability Law Service might be able to help. Good luck.

16

Hi, I had the same about 15 years ago I put in a claim after receiving the diagnosis of RRMS, it was declined and the policy cancelled due to the fact that I had failed to say my appendix had been removed at the same time as an operation for adhesions. They are bas…s A slip of mind, nothing to do with failure to divulge information resulted in this decision.

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Did you fight it? And if so what was the outcome?

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Cath,

thank you for your reply, it is very stressful. You have this insurance in place for such circumstances and they’ve now declined it. We’re in the process of going to the financial Ombudsman Service and I’m just getting the final bits of evidence to support our claim together. The insurance company have offered £200 compensation due to the poor service received which I’ve declined and said in no way does that reflect the stress and worry they have caused.

Fingers crossed we get the same result as you from the financial Ombudsman Service

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