Scottish Provident & Legal & General Critical Illness and mortgage protection dilemna

[realdeal]

I was diagnosed with IBS and chronic depression last July/August. I filed a claim on my critical illness policy with Scottish Provident and also filed a claim on my mortgage protection policy with Legal & General after the necessary period of time elapsed. I filed for these claims in November 05 and Jan 06 respectively.

Both companies are working in tandem and they have received all the required medical information from my GP and my Clinical Psychologist. I have had two seperate claims visits with Rubicon and I now have to attend an independent medical assessment with a consultant psychiatrist on 24th June.

Rubicon have also been commissioned to conduct an employer visit which is yet to be confirmed.

My employer is not really cooperating with the insurance company's requests and I've had to involve my solicitor and I could possibly have to sue them, (my employer), for Disability Discrimination as they have tried to conduct a redundancy process during my illness as a result of a management restructure. The insurance companies have told me they need to assess the possibility of a litigation claim and any other obstructions that may exist in me possibly returning to work. My employer has since put the redundancy process on ice. The insurance companies are also claiming that they need to determine if my illness is a result of work related stress which, if it is the case, they will not pay out on my claim although I don't recall this being stated in my policy......I'm also sceptical as to what, (if I did decide to sue my employer), my legal stance has to do with my medical insurance???

Can anyone give me some advice as I feel the insurance companies are undertaking unnecessary delays and in the meantime I'm going slowly bankrupt....

[Bookworm]

Well, the very first thing I'd say is check your policy. If you don't have it, ask them for a copy. A lot will depend on what it says there.

Once you have it, I'd like a look. Get back to me, and we'll take it from there. Like you, I smell a rat and what's more, I have a nagging feeling I have heard the name of that company before as a problematic one.

Let me know.

[realdeal]

HI bookworm....thx for the reply.....I do have a hard copy of the policy and there is no mention of depression or IBS in the document. Also there is no mention of illness as a result of work related stress being a cause to dismiss my claim.

I've since contacted the FSA and sent a letter of complaint to both companies which I have faxed this evening and sending via registered post tomorrow......

can you suggest anything?

thx again for showing interest

realdeal

[Bookworm]

Ok, I think we have 2 issues here. Remember I do not have your info here, so be patient with me.

First of all, how can you claim on your critical illness policy? Neither IBS nor depression come under the heading of critical illness, so I'm confused how this one gets into the equation. And second, what is that policy meant to cover you for? Is it to cover payments on something? Or to provide you with an income? Can you break this down for me, please?

Mortgage Protection. Mhhh, ok. More clear cut in some ways. You're signed off, you have cover, if your condition is not under the excluded ones, they should pay. Simple as. Are they not paying anything at the moment? That's BS.
I think, reading between the lines, that their problem is this. Your sick time and your redundant time might "overlap". A redundancy payment would compensate for so many projected weeks/months of loss of salary and pay accordingly, and your unemployment insurance side of things would only pick up when that part of it had ran out. whereas a sickness one would be continuous from moment of inception till you are fit and well enough to return to work. I'm sorry, no matter how I phrase it, it's complicated.

However! Since you can not be made redundant while you're off-sick, I don't see that it should cause them that much of a problem, except of course, they want to pay as little as they can get away with. Because it is quite clear that no matter what your company is up to, you are signed off-sick, they should be covering your mortgage under the sickness part of your PPI, and that's that.

Finally (phew), I do not see either whether your illness is work related or not has anything to do with them. If they feel it does, then they should try and recoup their costs from your employer (that could be fun to watch!). But withholding payment on such a flimsy pretext seems beyond the pale.

That's my opinion. I must tell you that I'm not a professional in the field, that I am not in possession of all relevant facts, and that this is just that: my opinion.

But if it was my claim? I would be jumping on them until they cough.

PS: Insurance Ombudsman actually has teeth and uses them. And often leans towards customer...

.

[realdeal]

Hi Bookworm,

thanks for that.......if it helps, my policy with Scottish Provident is Disability Income Benefit (sickness, accident or disability) whereby its all in the definition of "disability" which in the policy states:-

" "disability" means they are, in OUR opinion, due to illness or accident, unable to perform the material and substantial duties of their own occupation as disclosed at the time the is accepted by us."

my condition is not mentioned in either policy under the exclusion clauses....

whatcha think?

thanks again

Realdeal

[Bookworm]

Still need to clarify this. What does it do? Provide you with an income? Pay for something?

If it is to provide you wth an income, that's why they're sniffing around the redundancy/illness issue, IMO.

Sorry, lightbulb moment here. I think I've just twigged why they're so interested in the potential tribunal. Again, it's a forward projected compo issue, if you will.

If you take your employer to ET, and you win, there is a complicated calculation of yrs of employment x salary, ewtc... (can't remember the exact one, but you get my drift). If you were on JSA for example, when your award came through, the JSA wd be deducted from your total award as you can not get paid twice, and since you have ben compensated, the state takes its cut back. Likewise the insurance. They don't have to pay you an income for the time where your employer has effectively been made to pay you by the ET. Is that clear for you?
Therefore, of course, the insurers will be VERY anxious to know whether there is anything in the offing as they would then be able to mitigate their loss. God, they're crafty.

This doesn't deter from the fact that they are not paying when they should. Sadly, they have a habit of standing back and see what gives before paying up.

.

[realdeal]

thanks Bookworm,

the policy provides an income.......hope that helps...

wot does JSA mean? what if I settle before it goes to ET? sorry for all the questions!!!!

At the moment I've told the insurance companies that to date I have not filed any legal proceedings against my employer. They sent a letter to me saying they had insufficient detail regarding a compensation claim against my employer but I've written back telling them I've made no such claim.....yet.....if my solicitor settles without filing for ET does that count?

thanks again for the advice bookworm.....

realdeal

[Bookworm]

Sorry. JSA = JobSeeker's Allowance. AKA The Dole .

You do not have to file against your employer, for whatever reason you choose. And if you don't, there's F*** all the insurance can say about that.

Have you spoken to your solicitor about the insurance issues? Or would that be too costly? This is a rather complicated state of affairs, and I think you may well need professional advice down the line. I'm happy to help as far as I can, of course.

In the meantime, try talking to the insurance, phone them every day of need be, stay on top and let them see that you're not going to go away quietly. Might be a good idea to write and let them know that in your state of depression, their own attitude is not helping, etc...

Make sure you get a copy of the independant assessment once carried out, it's your right.

Chase up that employer's visit and insist it gets done asap.

That's allI can think of in practical terms at the moment.

[realdeal]

Bookworm, you're an absolute gem....thx for your thoughts and advice.

Basically I am not claiming any state benefits at this stage as I naievly thought my insurance would've come through at this stage :o

I will have a brief chat to my solicitor about it but she does cost £220 per hour and her involvement with my employer at the moment is costing a fortune!!!!

What you were saying before regarding a payout as a result of an ET and how the insurers would look to offset their payments against; would this also hold true if I did have to file for ET but it's settled before it actually reaches tribunal?

I've tried to find some case law regarding insurers not paying out when redundancy is an issue but there isn't anything I've been able to find so far. I did find something regarding compensation and payouts on the Association of British Insurers website but nothing specific to redundancy and how it affects insurance payout.....could you recommend anything?

Thanks again for all your help

Realdeal

[Bookworm]

What do you mean, you're not getting benefits? What about SSP? That should be paid through your employer, at least the minimum provided by the DSS, and possibly more depending on your employment T&Cs! What are you living on at the moment?

ET and settlement: Yes, very likely. To put it in simplistic terms: you can not get paid twice for the same period of time. If you receive compensation destined to cover an allocated period of time, say 12 weeks as an example, the insurance would not cover those same 12 weeks, and would start providing you with an income when the work payout would end. I'm talking about your income policy here, not the mortgage one, btw.

I don't know any books of that kind, no.

You might want to check ACAS site though:
http://www.acas.org.uk/
They have lots of leaflets and booklets regarding aspects of employment and ETs. Some explain the double payment rules very well, and although I appreciate that your predicament is with the insco, it might help for you to get your head around the principles.

I'm glad to be able to help, but tbh, I'm way way out of my depth here. There are so many ramifications, so many interested parties, all with only one thing in mind: trying to mitigate their costs. At your detriment.

I hope you can talk to your solicitor. TBH, it may well be worth your while going to the CAB, they may well have access to the type of information you need. And they don't cost £200 an hour, even if it means sitting there for an hour waiting your turn. They are worth every penny they don't get!!!

.

[realdeal]

thanks for this bookworm,

my SSP ran out in feb/march according to my employer although SSP only appeared as a seperate item on my wage slips in November....solicitor looking into it.......surviving on mortgage reserve at the moment and £600 pm car allowance......

gonna see the CAB next week....I'll keep you posted!!!

Thanks again for your thoughts and I hope to make a donation as soon as I get my insurance....(could be a while!!!!)

Realdeal

[Bookworm]

SSP is Statutory Sick Pay and can last for up to 28 weeks. Does that sound right?
Since then you might have been able to get Incapacity Benefit.

Mention this to the CAB as well. It seems to me that on top of your insurance trouble, you may well have been missing on your basic rights. Of course, it's hard to tell without knowing all your circumstances.

Make a list of all the things you need to discuss with the CAB. Take as much documentation as you can.

Good luck and let us know how you get on.

[realdeal]

Hi bookworm,

the CAB have put me in touch with DWP and they tell me I'm eligible for incapacity benefit and income benefit. I have been told by my other half that it is risky claiming income benefit as it may affect future mortgage applications. what do you think? DWP are calling me am on Monday to finalise claim details.

have appt with CAB on 17th july, will let you know how I get on.

have sent 30+ pages of complaint to both Scottish Provident and Legal & General so now have to wait the 8 weeks for the response of their investigations before bringing the full weight of the FSA down on them.

Regarding SSP, it only started appearing on my wage slips as a seperate item in Oct/Nov 2005, ( I was signed off ill by my GP in August 05). My employer claims the company sick pay I'd been receiving before then had also included SSP. My solicitor has asked for clarification of the dates but my employer is not responding....I feel a tribunal coming on!!!

will let you know how I get on with everything as events unfold!!!

Realdeal

[Bookworm]

I don't know about the income benefit/future mortgage applications, tbh. If you have worries about that, make a note of clarifying with the CAB when you see them, they'll probably know more about it.

If there's a chance of that, I would weigh the current risks of possibly losing my home now if things got worse, against the possibility of hypothetical future mortgage applications, and decide accordingly.

I'm glad to see that your whole outlook sounds less bleak and that even your "tone of voice" is so much more positive! Definitely the way to go!

[realdeal]

hi bookworm,

thanks for that, feel more positive now that I'm more aware of my rights and entitlements!!!

Spoke to my IFA about income benefit and any negative impact on