Diagnosed with RRMS. Critical illness claim refused!!!

Everyday living
1

Hi everyone

I’m a newbie here who is looking for some advice.

I was recently diagnosed with RRMS which is having a negative impact on my day to day life. Both myself and my partner think it would be best to reduce my hours at work to focus on my health a bit more. I currently work full time 35 hours a week over 5 days. Ideally I would like to work 21 hours over 3 days, which my employer has agreed I can do if I need to.

The catch is that in order for me to reduce my hours I would need my critical illness cover to pay out to make the financial side of life easier. The cover was taken out through my employee benefits (I work for a high street bank) and no medical questionaire was required before the cover began.

I submitted a claim and have received a letter from them today rejecting my claim on the basis that a few years before I took out the cover I was referred to a Neurologist due to my migraine headaches/tingling in finger tips. A cervical spine MRI was carried out to check for a trapped nerve. Nothing was found on the scan and the Neuro didn’t take his investigations any further. I was referred back to my GP who prescribed migralieve tablets and I was sent on my merry way.

My ciritcal illness cover has therefore decided that this was probably my first sign of MS and the Neuro should have known this!!? They are therefore not willing to pay out as I probably had MS before the cover was taken out (the cover began last year).

How was I supposed to know I had MS if no-one told me and also why should I lose out because the Neuro I saw was either incompetent or didn’t think MS was a possibility?!!

In addition, I don’t see how they can reject a claim on previous medical history if they didn’t even bother to question it before the cover was taken out.

Has anyone on here had a similar experience or can anyone give me any advice/opinions in relation to this matter.

It has really knocked me for six today. I thought I had protected myself and my family by taking out critical illness and now I don’t know how we will carry on financially. It feels as though I will have to either compromise my families standard of living or my health.

It just doesn’t seem fair.

2

Go to the Insurance Ombudsmen as they are looking for reasons not to pay out and the Ombudsmen take a very dim view of this behaviour. You have a very strong case

John

3

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.

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, hope this helps, as you say if nobody told you pos MS how was you to know?

George

4

This sounds too familar, insurance companies digging through notes to find reasons not to pay critical illness cover. Some are worse than others.

Out of curiosity who were you insured through?

5

I had 2 Critical Illness Insurance Policies: one with the Mortgage and one at work. The one with the Mortgage paid out but the one from work didn’t as they saif I had had symptome in the first two years before I was even diagnosed with MS! I agree with George there is a “Wriggle out of Claims Department” with Critical Illness.

6

Hi Guys

Thanks for your responses.

I think there is a clause that states they will consider previous associated illnesses if a claim is submitted within the first two years of the policy start date but I can’t see how they can uphold this clause given that they did not research my medical history before accepting me for cover.

I also find it ridiculous that they would consider migraine headaches a get out clause in this instance. I mean how many people out there have gone to their GP because or recurring headaches? I imagine most people have complained about this sort of thing at one time or another. I just feel that if they were going to pick through my medical history before making a decision then they should have reviewed my records before allowing me the cover.

7

I [quote=“Anonymous”]

Hi Guys

Thanks for your responses.

I think there is a clause that states they will consider previous associated illnesses if a claim is submitted within the first two years of the policy start date but I can’t see how they can uphold this clause given that they did not research my medical history before accepting me for cover.

I also find it ridiculous that they would consider migraine headaches a get out clause in this instance. I mean how many people out there have gone to their GP because or recurring headaches? I imagine most people have complained about this sort of thing at one time or another. I just feel that if they were going to pick through my medical history before making a decision then they should have reviewed my records before allowing me the cover.

[/quote] Thats why i have suggested the Ombudsmen because he will have the same opinion as you regarding your last sentance

8

Ask your current neuro to confirm the diagnosis of migraine and state that it has no bearing on the diagnosis of your MS. It is perfectly possible to have migraine and MS as two separate medical conditions.

That might help. And get on to the Ombudsman.

Cheers,

Belinda