Hi, recently put a claim in as I have been recently diagnosed with RRMS in December 2024, policy was taken out September 2022.
I thought I was in the final stages as GP and consultant have both sent their forms off and the under writers where in the process of the last stages, should have gotten a decision this week but assessor rang to say they noticed PCOS on my medical notes. To my knowledge I was never fully diagnosed and yes was going through some gynae appointments in the past but I answered no in 2022. I’ve been in contact with GP and they confirmed I was diagnosed in 2016, no one ever told me. They want further information now and about gynae history as it looks like I’ve lied now back in 2022 when I took the policy out even though i genuinely didn’t know.
Is this going to affect my claim getting approved?. I know the 2 have no connection with one another but are they going to say this was a non disclosure and reject my claim? It is a lot of money and was really hoping for yes!
In my opinion if I knew about the PCOS and did declare it back in 2022 I would not have seen a reason that I wouldn’t have ben approved or even that my premiums would have went up as I do no have any other illness and young and fit, well apart from being diagnosied with MS now.
Hi @Ems29 Sorry to hear of your situation and also sorry but I can’t answer your question. Might be a mater of looking at the small print of your insurance cover.
if I were you I would be kicking up a bit at the GPs! If they say you were diagnosed then why on earth haven’t they talked to you about it, how to manage symptoms, any treatments and what to expect. I’m absolutely no expert but thoughts of medical negligence would be popping up in my mind!
If there is a piece of paper that says you’ve been diagnosed, then you’ve been diagnosed. Unless it was written in error, but we’re going back 10 years so will be hard to prove.
If we assume it was correct, then as Hank says, there’s a whole load of knock-on issues. You will have been mis-declaring on all sorts of forms and policies during that time. And potentially paying premiums on policies that would not have provided you with cover. It’s a terrible predicament for you and very unfair but up to you to decide if it is worth the hassle of finding someone to blame. I got misdiagnosed and wasted a lot of time when potentially I could have been receiving treatment but in the final analysis, I’ve got this one body to live in and no amount of litigation or compensation is going to change my life from here on.
I am sorry that you have this stress and worry to deal with. I don’t think there’s anything for it but to wait and hope for the best. Fingers crossed that all will be well.
Hi again, a good number of years ago it was a lot of query or suspected PCOS, it was only when I got in contact with my GP last week and she informed me that yes I was diagnosed in 2016, I made it known that no one ever told me whatsoever apparently a referral was put in for gynae in 2018 but I’ve yet to hear anything, so when I took out the policy in September 2022 the last I heard anything Gynae related or PCOS was probably back in 2017 maybe early 2018 so that’s a good four or 4 1/2 years where I had nothing no news. Obviously, if I knew I’ve been diagnosed and yes, I would’ve declared this when I took the policy out.
My GP said that she will wait for the further documentation from the insurance company and she says she will put a statement to state that all the notes say patient has been diagnosed but will make some sort of note to say the patient was never officially told of her diagnosis, so hoping that might strengthen my case.
At the end of the day, PCOS, and MS has no correlation whatsoever. But yes, I can see how it looks like I’ve lied when I took the policy out.
Is there anything else I could maybe do to try and get further support to strengthen my claim perhaps maybe get in touch with my consultant/neurologist and see if she can be explain that there’s definitely no link between the two?
Sorry for what I am about to type but insurance companies are uncaring.
My story, I was diagnosed on 3 April 2007. I had a personal insurance policy with my work. I had worked for since 2005. My claim was denied as I had a bought of optic neuritis. Optic neuritis IS NOT a precursor to MS. My claim was knocked back as a result of this. Like you no lies or misinformation on my part, resulted in it being denied 3 times. First time my application, second time when I got a lawyer to send the firm in for me on a no win no fee. Third and last time when I got my MP to write to them. They just stone walled me. Hope you have better luck than me
Optic neuritis is a common **eye problem**where inflammation or demyelination affects the optic nerve. It is a condition in its own right, but is also strongly associated with multiple sclerosis. Not everyone who experiences optic neuritis goes on to develop further symptoms of MS, but a significant proportion do.
For 1 in 4 people with MS, optic neuritis was the first MS symptom that they noticed.
From
Insurance is based on statistics. If someone has had ON they are more likely to develop MS. If the incident is not disclosed they have not been informed of the increased risk and could legitimately dispute any claim.
Like many others, my Optic Neuritis was the first real symptom of MS and it was ON that prompted the hospital to give me an MRI scan of my head which showed ‘quite a few lesions’
I understand stats, economics degree with statistical analysis.
Point I was making is I am not medically qualified to say what is a precursor to MS. Official line from the hospital is that it is not a sign of MS. Consultant and my MS nurse told me this.
I hid nothing from the insurance company, I stupidly took it in good faith that my insurance would payout.
So as a dunderheid, Glasgow slang for someone not that bright, how would your average person know that an eye condition 2 to 3 years earlier would lead to MS when this was not mentioned until diagnosis?
I’m kind of surprised that your consultant said ON is not a sign of MS! The most frequent cause of ON is MS and lots of people with MS get ON. There is a strong association!
I know what you are saying, the fuss I kicked up on this got 1 thing done in parliament.
group critical insurance should be clearer to your average person and refusal of a claim should not be so generic
Whilst I hear what you are saying hank, to certain extent I do agree but the point I made was to get the insurance companies to be more transparent. It has been a bee I’m my bonnet for a long time especially if it was personal critical insurance, it would have paid put. Kid you not. Just do a basic Google with private critical insurance pay outs with MS and optic neuritis.
When I first had ON, the doctor didn’t even mention MS. I wasn’t warned by any medical professional at that stage. I was the one who googled a lot and found a scientific publication with chances of an MS diagnosis after ON. The thing is, not all medical professionals straightforwardly tell you that an MS diagnosis can follow.
Sorry to hear you’re having all this trouble with your critical illness insurance payout.
As far as I am aware, there is no association between your gynae condition and MS.
But I guess what it will do will mean that they will look at your records more closely 'in case you have been lying’. They might ask more questions.
They probably have a policy : procedure at the company that they follow when they find something in the records that was not disclosed. You might be able to ask what that policy / procedure is.
Ultimately though, if you policy covers MS and you meet those conditions : part of the policy, then they should pay out.
Mine have just paid out. It took about 4 months from making the claim to them assessing it and accepting / paying the claim. As far as I am aware there were no complicating factors in that. I share that jsut to give you an idea of how long it takes.
Again I’m totally surprised that no one suggested that ON could be a sign of MS. I could understand it’s if it’s was your GP - jack of all trades but master of none but if you are talking about a neurologist then that’s totally unacceptable.
Except for basic, common illnesses GPs act as a sort of triage service and yours should have referred you on for further investigation. Far too many cases of such failings across many illnesses/ health conditions
Not totally sure what you are saying but yeah, don’t rely on group critical illness insurance / read the small print etc. For private medical insurance- you won’t get payouts for pre existing condition and your consultant was totally wrong to say that ON is not a symptom of MS when in fact it often is