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MS Diagnosis and Critical Illness claim - what next?

I was diagnosed with MS in November 2014 at least I thought I was up until yesterday.

After having symptoms from August 2014 (leg numbness, arm & shoulder numbness, tingling, shooting pains, fatigue, itching, loss of balance) (and more recently tinnitus but is that MS?) I saw a neurologist and had brain and spinal cord MRI scans.

He told me I was had numerous lesions and therefore had MS and he would refer me to an MS nurse at our local MS Clinical Specialist Service. I didn’t know what kind of MS until I had taken a course of steroids and because they had a positive effect on the skin numbness I was told it was RRMS by the MS Nurse. I continue to have leg weakness and difficulty walking if I am hotter or colder than usual as well as the other symptoms but the skin numbness has gone.

All subsequent correspondence from the MS Nurse has “Diagnosis: Relapsing remitting multiple sclerosis” at the top.

The MRI report says " …T2 hypertense lesions in both cerebral hemispheres - some are periventricular and others are subcortical or juxtacortical. There are also lesions in the corpus callosum, left cerebellum, brain stem and spinal cord"

I have insurance with critical illness cover for MS so started a claim in January but in yesterday’s letter they now say the neurologist says I have a clinically isolated syndrome so not MS.

So after 6 months of stress with this diagnosis thinking at least I am covered financially (I am self employed with 2 young children and cannot work as much now) it turns out I am not covered(!!)

Does anyone have any experience with this or any advice on what my next step could be please?

Sorry I have no experience of this, try posting in everyday living you may get a better response there.

Good luck.

Jan x

Hi I am not diagnosed yet but I have critical illness cover and from my experience they will try anything not to pay out if they can help it.Did you ask to see any report your consultant was asked to send before he did so you had the chance to question anything you thought was contradicting what you have been told in tne past.If you haven’t seen the report you can ask for a copy and if you are seeing the consultant again question him about it.I think it is odd that he has given them a different diagnosis to the one you have been given.I was sold my policy to cover accident/illness anything that meant i couldn’t work but when I was attacked at work and left with 3 damaged discs in my neck 15 years ago they only pay their premium on a waver or premium claim.I hope this is helpful and try to appeal the decision or at least find out why the consultants report is different.Good luck you could try citizens advice.Sue

Just as Stella says they will try anything to get out of paying a claim.

You have a win-win situation though. If it turns out to be CIS; great you will get better. If on the other hand it proves to be MS your insurance will have to pay.

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.

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

do you stil have the issues? As CIS is usually defined as an isolated improved incident?

Hi Everyone

Thanks very much for your advice.

The insurance company did not ask the neurologist to send me the report before he sent it back to them even though I had asked them to(!) so I will ask for it now.

I spoke to the neurologist on Friday about the diagnosis. I asked why he didn’t say I had MS and he said he just answered the questions on the form and he said “I did not put that you have not got MS”. I said yes but you didn’t say I do have it!!!

My initial symptoms were all in my left leg in August when I was first referred to the neurologist then that numbness went and I felt ok but my leg had muscle weakness. I didn’t want the MRI because I suffer from claustrophobia . It was then in October that I had new symptoms (skin numbness, pain, itching) on my left shoulder/arm pit/arm and I decided to have the MRI. It took steroids to get back to ‘normal’ but I still suffer mainly with the weakness in my left leg (but also with bumping into things and fatigue!) - probably more as time goes on.

I think maybe the question is whether these two episodes in August and then October are separate or are seen as one first attack?

I have an appointment with him in three weeks to talk about my ongoing symptoms so hoping he will write to them to say I do have MS and I will appeal the decision.

Even though I have probably had MS for several years according to the MS nurse (because of the MRI results?), I have had this insurance since 1992 so I am determined to fight for this!

Jane