think there will be a battle ahead with critical ilness claim pls advise

Everyday living
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Just had a call from my critical illness company. They said that my consultant has said that my legs pain is due to anxiety so there will be a problem with my claim after hes seen me twice.heis known for being rubbish with symptoms. My consultant thinks ive had 1 relapse eventhough I got lots of different symptoms back to back based on my mri in january as this had improved. I saw a different neuro last week who said id had 2 or 3 based on symptoms not mri but that the leg pain was unusal in ms he kept telling me my consultant was very good, he had obviously spoken to him . I have had cbt and my physiologist doesnt think its health related anxiey

but whether or not she will write this as she works with the neuro who has rubbished my symptoms. My claim states you have to have had symptoms for 6 months. Im on gabapentin, amitriptyline in order to function, have been awared dvla, mobiliy and yet they are going to try and get out of paying the claim. Any advice what I should do xx

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Hi Zoe,

Sorry this is NOT an answer to your question but just some advice on CI.

You are right to be apprehensive about your CI but as you can see from the article below you should be alright.

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.

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.

George

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Diagnosed oct 2012, problem is u have to have symptoms for 6 months, consultant says yes she has ms but pain, limp etc are anxiety related…

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i would get in touch with the insurance ombudsman.

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Hi Zoe,

I only needed relatively trivial symptoms after six months to qualify. You do NOT have to be incapacitated. Physio happened to have noticed weakness of my left ankle - that seems to have been sufficient. I hadn’t fallen over or anything, and I definitely don’t walk with a stick, or even a limp. The physio exam hadn’t been in support of my insurance claim - just something he happened to have noted. I think the fact I was even seeing a physio six months later must have been a clue something was up, even if it was fairly minor. Nobody has physio for nothing, do they?

I thought you were on either gabapentin or pregabalin? (Sorry if I’m mixing you up with another poster!) What the heck are you needing this neuropathic symptom relief for, if you don’t have any residual neuropathic symptoms?

Unfortunately, I think the drugs can occasionally be prescribed for anxiety, so the idiot might have said they were prescribed for that. But if they were prescribed for MS, there shouldn’t be an issue. Why would you be taking drugs for symptoms you don’t have?

Tina

x

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Zoe,

They are just trying it on. If I were you I would gather all the supporting evidence you can, eg GP, nurse, physio and prepare for battle and don’t give up.

I was really lucky with mine as they both paid up without any questions.

Good luck

Emma xx

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If your consultant sends a letter saying you have been diagnosed with MS then that’s the end of it.

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I dont understand how your consultant can say that your pain is related to anxiety. Pain is a common symptom with MS. I would get in touch with your MS nurse, if you have one, and discuss further.

Having said that, you have MS and that is certainly a fact so keep plugging away.

Best wishes

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I was dx with Ms then claimed. I did nothing more they told me they were waiting from info from gp. The next I new the money had been deposited into my bank. All very easy.

They never asked about symptoms just positive dx

Hope you get sorted out x

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It depends on the policy. Some policies are different to others. I know the one I had (which my ex cancelled a year before diagnosis - typical) I would have had to have symptoms for 6 continuous months. My initial relapses wouldn’t have qualified me as I went into remission after 3 months on each occasion.

Check the wording of your policy.

The problem here is really with the consultant and not the insurer. The consultant is saying your leg pain is not an MS symptom, therefore the insurer is within it’s rights not to recognise it as one. The consultant is the expert after all and the insurer can only go on the information given. They are not neurologists.

Have you other symptoms other than leg pain?

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Just to add, the mobility and DVLA are irrelevant unfortunately. Your policy will only cover you if you are diagnosed with MS and have symptoms for 6 months. The consultant is saying your symptoms aren’t MS related. Therefore the CI policy won’t pay out yet.

Being honest, you won’t have a case until you have MS symptoms for 6 months as stated in the policy. That will either involve you neuro saying the leg pain is caused by the MS or you developing new symptoms for 6 months which the neurologist confirms as MS symptoms.

I work in insurance (a different type of health claim) and the policy is fairly specific and any ambiguity isn’t enough. I would advise working on the neuro and getting them to find out the cause of the leg pain or going and getting a second opinion. I wouldn’t say the insurer are trying to wriggle out of paying the claim per se, but their criteria are pretty clear and you haven’t met the criteria for payment yet, based on the info they have gotten from your neurologist. Therefore the ombudsman etc won’t be in a position to help because the call is really coming from your neuro and not the insurer.

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Can we not name and shame these companies? I had cover with Aegon and they were excellent.

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[quote=“stevie”]

Can we not name and shame these companies? I had cover with Aegon and they were excellent.

[/quote] I had cover with Standard Life and Scottish Provident. Standard Life took 16 days from first call to money hitting my bank account! Scottish Provident was about three months but paid out with no problems. Standard Life was actually the big one (mortgage cover!) too!

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I don’t think the company is doing anything wrong, if they follow the strict wording of the policy.

It’s not uncommon for policies to have a clause saying some form of impairment must still exist, six months post diagnosis. Mine did, but it was not a problem at all, as they accepted quite a minor impairment (weak left ankle, as identified by the physio), which I wasn’t even aware I had!

The problem here appears to be the neuro’s insistence ongoing symptoms AREN’T caused by MS. I don’t think any policy with one of these “six month” clauses in it is likely to pay out if the neuro is claiming recovery has been complete, and any remaining trouble is unrelated!

In all probability, it will pay out eventually, because we all know that, MS being what it is, it’s likely there will be “permanent” damage, or at least lasting longer than six months, over the long term. But until that happens, AND the neuro is willing to confirm it, it won’t pay out. Second opinion from a different neuro (preferably one who trumps the first in qualifications or experience) might fix it.

Neuros must deal with insurance claims all the time, and know how policies are worded. It’s odd they would insist symptoms were unrelated, even knowing this might invalidate the patient’s claim. I assume he must sincerely believe they ARE unrelated - but pain is very subjective and difficult to prove, one way or the other - that it even exists, let alone the cause.

Zoe, I wonder if you’ve had a physio assessment, that would actually show something was weak (like my ankle was)? One side being measurably weaker than the other is more concrete evidence than pain, because pain, no matter how serious, is always open to interpretation. You cannot prove you’re experiencing it at all, and there’s no test that will prove it. So basically, a symptom that’s entirely self-reported, and can’t be tested, may be another reason the policy won’t pay out.

Tina

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Name and shame them for what though?
They aren’t doing anything wrong. If the policyholder hasn’t met the criteria for a payout, then there is no “shaming” involved. The policy is still in force and if or when the OP has symptoms which meet the policy criteria, she can make a valid claim. At the moment her neuro is refusing to say she has had MS symptoms for more than 6 months. The insurers hands are tied if the policy is not one that pays out on diagnosis alone.