Diagnosed yesterday - now want to claim on Critical Illness

Everyday living
1

I got my diagnosis yesterday with my first symptom being mid January of this year. According to my critical illness cover, I need to fit the following criteria:

A definite diagnosis of multiple sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

I am worried on many levels as I’m not sure how I prove that the symptoms have been continuous because, for example, my consultant letter back in February stated that symptoms appeared “normal” although even at that time I stated that I still had numbness and leg weakness but he said that the feeling would just come back on it’s own but still although the numbness isn’t so pronounced, it’s still there.

Any advice and when is best to ask for a claim form, etc as to my reckoning 6 months from the day the symptoms started would be 12th July and I went to the doctor a few days after that?

Also slightly worried about non-disclosure. To my knowledge I completed the form as accurately as I could when I took out the policy 5 years ago but I wouldn’t have remembered every single doctors visit but assume they would have got a full report from the GP to cover this sort of thing?

2

Hi, I would claim at once, as the six-month thing is a standard clause, and not ALWAYS an issue. My policy still paid out, even though symptoms after six months were very superficial, and not really provable (nobody in the world can prove things like buzzing, as far as I know, or even pain). You may not have much choice anyway, as quite often there is a strict time limit to claim (mine was three months) and the clock starts ticking immediately on diagnosis. So if your plan was to defer until you’re sure of satisfying the six months’ continuous symptoms, you may find you’ve missed the deadline to claim anyway. As for the non-disclosure, I’m afraid it is solely your responsibility, NOT the insurer’s, and no, they will have accepted your application in good faith, and not commissioned doctor’s reports to check (very unlikely, anyway - you would have been asked permission if they were going to). So it all hinges on whether you left out anything important. You wouldn’t be expected to have listed every time you went to the doctor for a cough or cold, or a verruca or something. But if you have a history of going about things that (with hindsight) look neuro related, it might be considered a serious omission. I had been to the doctor’s several times with aches and pains, and once with an unexplained “sore leg” (now sure this was an MS relapse). However, because nothing I’d complained about was obviously neurological, and in themselves, no single incident amounted to anything very serious at all, it wasn’t concluded that either I or my doctor should have had grounds for suspicion. If I’d had a more classic early presentation of MS, such as optic neutitis, it probably would have been counted as serious enough to void the policy, had I not mentioned it. But luckily I’d only had a mish-mash of mostly trivial and seemingly unrelated symptoms prior to diagnosis, so there was nothing to say: “Someone should have suspected”. I’m assuming, five years ago, you hadn’t been to the doctor about anything neuro-related, or that might have looked that way? No sensory problems, vision, balance, coordination etc? Never been referred for an MRI until lately? No existing long term conditions that you failed to disclose? If no to all of that, it should still be OK. Tina x

3

Thanks Tina. The only thing I did have that I can think of was shingles 13 years ago but other than that no, not really to my knowledge. It’s just at the age of 40 you can’t really remember everything but I think most of my doctor appointments over the years have all been for trivial things (or pregnancy related).

Well I can’t change anything now and will do my best to claim. Will ring for a claim form today if you don’t think a month or so here and there will make a difference.

Thanks for the advice x

4

Well, they all vary, I suppose, but the continuous symptoms thing did not seem to be an issue with my insurers.

Claims take at least a few weeks to process, so by the time anyone is having to actively consider whether to pay out, I would imagine you’ll have passed the six-month milestone anyway. And if not, at least your claim will already be in the system, ready for when you do reach the six-month mark. Better to put it in sooner, IMO, than put it off, and face: “Why didn’t you claim as soon as you knew?”, or even: “You have missed the time limit for claims!”

As for the proving - many MS symptoms are almost impossible to prove anyway. If you went to the doctor the day after the six months, would she be able to PROVE you’ve still got minor numbness? I can pass the “pinprick” test, even though it does not feel, to me, as I know it should - i.e. it is so subtle that I can tell the difference between sharp and blunt, yet “sharp” does not feel so sharp to me as I know it once did - i.e. it feels a bit like somebody doing it through a towel, or as if there were a plaster on the skin, dulling the sensation slightly.

My physio notes did say I had a weak ankle and a couple of other things, but they were so minor I was not even aware of them until he said, so I guess that must have satisfied as my “persistent symptoms”. It doesn’t need to be very serious, and you certainly don’t have to be incapacitated.

I know it runs contrary to what a lot of people believe about insurance Cos, but in practice, they seem well aware that a high degree of recovery is likely, from early attacks of RRMS, and don’t use your recovery against you in the claim - they know it’s still a lifelong disease, no matter how much better you seem in the short term.

My policy was through work, and like you, I was worried recovering well would be a sticking point with my claim, but not only did they settle anyway, but I was told unofficially by HR that the company had had several prior MS claims, and it was not usually a problem, because they did recognize good early recovery is a common, albeit not universal feature of the disease, so would not usually oppose a claim on that basis. I know that has not proved true for everyone, and some here have faced problems about it. But I can only say what my experience has been, which was that they accepted it as a “normal” aspect of the disease, and not a reason not to pay.

I honestly can’t predict what the line would be on non-disclosure of shingles. Yes, it IS a nerve thing, and there’s some evidence it may be linked to an increased risk of MS. But if it was years ago, and had resolved completely, with no sign of complications, there’s not really any reason you should have thought of it as something you ought to declare. As you say, you can’t list everything you’ve ever been to the doctor’s about - particularly if there were no lasting consequences that you’re aware of.

I’m afraid you’ll just have to keep your fingers crossed they don’t seize on that as something that would have increased your premiums, or caused you to be refused cover. No way of knowing 'til you try.

Tina

x

5

Hi

My critical illness policy said I needed to have had moderate symptoms continuously for a period of at least 3 months and a definite diagnosis. There wasn’t any time limit on making a claim which was a good thing as I had totally forgotten about the policy and didn’t claim until a year after diagnosis!

I was a bit concerned that my symptoms wouldn’t be considered bad enough as they had calmed down quite a bit one year on. I had been left with a bit of tingling, numbness and fatigue mostly. However I put the claim in and my neurologist was obviously happy to confirm the diagnosis and the symptoms as the company paid out a couple of months later.

As long as you disclosed any relevant medical history (including any family members with neurological conditions) then they should pay out your claim. As Tina says, you cannot reasonably be expected to disclose all trips to the GP especially if they were considered irrelevant - if your GP did not suspect MS at the time then you would not be expected to disclose it to the insurers at the proposal stage.

Fingers crossed for an early settlement.

Tracey x

6

Hi Sorry to hear about your diagnosis - hope you’re staying strong. I was recently diagnosed & found my life policy, which I’d understood to cover Critical Illness, only covers me (when I read the finer print) for Terminal Illness. Which I suppose luckily I don’t qualify for…! From experience (I used to work in Financial Services) the more reputable companies don’t try to make it as hard for you as possible to claim - quite the reverse and I think that it is understood that ms can be so subjective and therefore hard to define and record symptoms throughout the early stages. I hope it all goes well for you. Jane Xxx

7

I’m waiting to see at the moment and am pretty sure it’ll be turned down as the Neurologist has written that I have no sensory/motor symptoms for 6 months. Interesting line as I have l’hermitte Sign and that is definitely there all the time since September. I do class myself as lucky at the moment as I tend to have the odd relapse that lasts 6weeks. Hoping my DMDs will control this. I have hardly seen the doctor as he has said ‘nothing he can do’ and I am flippin determined! Still, the extra money would really set me up and lessen the stress and allow me to rest when needed - being a teacher is full on but I love it! Anyway, I will be sending you positive vibes along with my own!

Good luck…on the positive side alot of people on this site have had their critical illness pay up immediately

Debs xxx

8

There’s an item on Watchdog tonight about insurance payouts for illness.

9

Watched that and thought sometimes those of us who went through the system of claiming had it easy! (I am one of the lucky ones on that point)

10

I missed it, wonder if I can find it on iplayer…

11

Watchdog highlighted Legal & General as a ‘bad guy’ and yet my claim with them was quite easy. It does all come down to full disclosure at proposal. Luckily I had always worked in finance and knew this so made sure I put full details down. I am also not the kind of person to visit the doctor unless something really worries me so although I had had instances of pins and needles, clumsiness and frequent cramp that I can (with hindsight) remember right back to my 20s, I had never visited the doctor about it as I could always find a plausible excuse for it … Who knows?!

Tracey x

12

Wish I’d known about this when I was diagnosed, would have claimed… wish I’d found this site years ago so much good advice…

Jen

13

Oh that’s a shame Jen. Well my husband feels sure that our insurer asked for a full GP report when we took out the policy and I seem to remember there was a hoo-ha that they said they hadn’t received it when our GP confirmed they had sent it. So I’m hoping the fact they took a GP report prior to insuring us will make life easier but I still feel worried they won’t pay out for whatever reason! Then again if you worried all the time about what might affect the insurance, we might never go to the doctors in the first place!

14

I applied for my critical illness cover shortly after diagnosis in June 2012, completed the forms and handed in the one for the GP to complete (at a cost of £32), sent everything off to the insurance company who in turn ultimately paid out in August 2012. I was amazed it was paid out without further investigation as my GP had put “Suspected MS” in her report and only one brief letter from a neuro stating he had diagnosed MS (which wasn’t actually confirmed until December 2012 following numerous tests requested by my regular neuro).

Pretty lucky I guess compared to others who are struggling to get something they have paid into. Let’s face it, nobody expects to ever claim on insurances like this and I was glad that, following initial diagnosis, I went into “organisation mode” and checked everything sorted which included checking my insurance policies and whether MS was included. My insurance also stated a clause but as I had been having strange experiences since the beginning of the year I suppose I fell into the 6 month time frame.

Hope those who are struggling get a solution soon as I know the money I received has been invaluable, although I have found the company I took critical illness cover from won’t insure me for life insurance now and trying to get life insurance is proving difficult because of the diagnosis.

Take care

Pen xx