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Will critical illness ever pay out?

I haven’t even been diagnosed but do feel the writing is on the wall and am awaiting the verdict next week. However, my husband mentioned that MS is covered by critical illness with symptoms lasting 6 months from consultant diagnosis.

Do you think it would ever pay out or do symptoms not usually last 6 months ever (unless you are in a wheelchair)?

Hi Yes it does :slight_smile: I was. Diagnosed April 2011 and never thought they would pay out but when seeing a financial advisor as we are looking to move he phoned Aviva for me and they said worth putting in a claim. It took me another few months until March to phone and spoke to a lovely lady who said they would write to my specialist. I knew he was on a 6 week holiday so I knew it would take a while to hear back. In May checked my online banking for something else and saw my direct debit had been returned. I phoned my bank and they said it was Aviva not them so phoned Aviva and they said they had accepted my claim. Next day money in my account plus all my premiums since diagnosis. Apologies for long post but still in disbelief as thought they would wait until I couldn’t work etc but apparently it’s on diagnosis. Tracey

Yes mine paid out no trouble.

As Tracey pointed out you do have to wait ages for the consultants to answer the letters.

Some policies have short times from dx to actually notifying them that you want to claim so make a call you have nothing to lose, if/when you are dx.

Pip

Yes mine paid out however at first they rejected the claim saying basically I was not bad enough. However my mum who was adamant I’d been diagnosed and had symptoms which I’d had for over six months so this meant it should be paid. After a letter from her on my behalf threatening to toto the ombudsman they paid out! Definitely made things easier although I’d rather have my health than be mortgage free. We aren’t mortgage free now as we moved however it meant we only needed to borrow a bit of money to move as opposed to the full whammy. It’s worth claiming x

Oh thank you, nice to hear positive stories re payouts! I would be a bit miffed at paying hefty monthly payments only for it to be worth nothing come the time it’s needed. So if I am diagnosed as having MS, I will be on the case!

Hi Tricky,

Bit late to the party here, but mine paid out, too.

Like you, I was a bit worried about the “continuing disability” clause - it’s relapsing remitting - Duh! That and the possibility they might challenge the diagnosis, as I hadn’t had a lumbar puncture - thought they might insist on that.

But in the event, all was fine. All they asked for was my GP records - all of them! They asked for the address of my neuro, but as far as I know, they never even contacted him, because his diagnosis was in my GP file, in black and white, in the letter he’d sent her. So I don’t think they needed to query anything, so they didn’t bother to contact him.

They either didn’t apply the continuing disability thing at all, or minimal disability was sufficient. Several months after my “attack” there were a couple of lines in the notes from my physio about weak ankle and foot drop (so slight I hadn’t been aware of either) - but looks like they must have taken that as enough. Or perhaps it was enough that I was even seeing a physio - it must have been an indication everything wasn’t perfect.

But overall, very pleased. My only criticism was they didn’t even tell me my claim had been approved, and that the money was on the way. It went into my bank while I was away on holiday in Turkey, so I didn’t even know it was there. If I’d had my card stolen, someone could have milked the lot! Not the safest process in the world, but all’s well that ends well.

Tina

Following on from Tina I had the opposite.

We were away on what we thought was probably the last holiday with both the kids,my sons girlfriend and my dad,and I had the call to tell me the money was going in in the next two days.

After that when anyone said can we afford it the “yes we are loaded” came out!!!

Pip

Hi

Mine paid out within a few months of DX.

MS was DX as I had problems on and off for a couple of years. I still walk and work (10 years later) and had no problems with the claim.

Good luck

Neil

I took out critical illness cover when I took out my mortgage a few years ago. There were no medical questions asked at the time of application. 18 months later I was diagnosed with RRMS and discovered that this was covered under the policy.

I made the claim and a few weeks later I got a letter telling me that my claim had been rejected due to ‘pre-existing symptoms’.

Before the MS symptoms began I suffered from migraines from the age of around 16. I was 28 at the time of my MS diagnosis.

The migraine symptoms were well noted throughout my medical records and it was one of these entries which the insurance company latched onto when reviewing my claim. On only one occasion throughout my entire medical history my GP had noted slight weakness in my left arm and tingling in my fingers. At the time it was assumed that it was linked to my migraine and that the symptoms were just changing. There was never any mention of MS or further mention of these symptoms until immediately before my diagnosis, which was around 2.5 years after my doctor mentioned the weakness and tingling.

My policy stated (in the VERY small print, I must add) that if I had ever suffered from any of the following ‘pre-existing symtoms’, prior to the policy start date, then any claim made within the first 2 years from the policy start date would be rejected. Two of the ‘pre-existing symptoms’ were weakness of a limb and altered sensation.

They therefore rejected my claim based on this one entry even though my Neuro believes the weakness and tingling were migraine related and not a direct result of the MS. I have tried to fight it but I’m getting nowhere. My Neuro has even written to my insurance company confirming that migraine can cause weakness and tingling in a limb and that he has never seen an insurance claim rejected or restricted in what illnesses are covered as a result of someone suffering from migraine.

Kept the cover on the Endowment (to lazy to cancel it, as it had been running since 1996) and knew the Endowment would fall short (again to lazy too change it). Once I was diagnosed (Nov 2011) I sent an enquiry whether MS was covered, as the original documents from Scottish Amicable (bought over by Prudential) did not mention it. Two weeks later I had a very nice letter saying ‘sorry for the dx’ but here is the application form. We then sat on it until a meeting to decide DMD’s with the doctors a month later, then filled it in. Had regular letters saying what progress the application was making, then they paid in full into our bank account with a letter saying ‘all done’ 2 months later. Thought it would look good getting a cheque through the post for loads of money but all done electronically.

I then had a few tears as thought there would be a fight to get it fully paid. I think it was then the acceptance of my health took hold as well.

Cloud with a silver lining, if we had pulled either the endowment or the PPI we would still have another 9 years on the mortgage and be worse off! (Endowment was running at a £10,000 shortfall)

Anon

please refer your complaint to the ombudsman. As an ex-insurance worker, I dealt with claims for private health insurance (where we paid out a monthly amount). Insurance companies will always try their hardest to NOT pay if they think they possible can - but tell them you’re going to make an official complaint to the ombudsman. They will give you the address.

This is what my policy says:

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.