Critical Illness Claim

[Englishbloke]

Hello everyone.

I have had a look through the forums and seen a few things on critical illness claims but I thought I would post to see if there any hints and tips people can give me...

I have recently been diagnosed (5 weeks ago) with a stage one seminoma (testicular cancer), I have since had an operation to remove the tumor and chemotherapy to try and stop it coming back.

I understand that the illness is covered (although have not had written confirmation) but it is the 'non disclosure part of my policy with Scot Prov that I am a little concerned about.

My IFA is '95%' I will get my claim approved but I am not so sure after reading lots of horror stories! I am worried that a cyst I had in my groin 10 years ago was not mentioned (even though I was told it was just a cyst, given antibiotics and it was never mentioned again) and I am also worried about other visits to the doc for minor ailments that were cured or dismissed by the Doc. Should I be worried?

When I took the policy I mentioned a few things, mainly a problem with my knee for which they requested my medical records. They had access to my records and my IFA told me that means I have nothing to worry about as they would have flagged thngs then but I think they will claim they were only looking for problems related to what I had declared?

Help! I know really I should wait and see but I can't sleep at night thinking about this!

By the way I have only had the policy for 2 years so I know they are going to make and extra effort looking at my records! Is this fair as they have already seen them when I took the policy?

Thanks in advance for any help!

[Bookworm]

The fact is that no, minor ailments don't count, and neither should something that got treated with antibiotics since it indicates an acute infection and nothing much else. When you filled in forms, you were asked about specific things, relating to certain parts of the body, also about relevant family history, etc... If you answered all these truthfully and not leaving anything out, you should have no worries.

The reality is that many insurances will try to find any which way not to pay up... and there's not a lot you can do about that except fight them all the way if they decide to play silly buggers.

Your IFA is mistaken however. If (and it's a big if) they had spotted missed stuff that could prove relevant, they wouldn't have flagged them (as in come back to you and ask you to clarify this), the responsability lies with you to reveal all relevant info and if in doubt reveal anyway and they'll decide if relevant or not.

Having said all that, you could worry yourself over and over, but you won't know until they write back, and that won't help you. So, concentrate on getting better, wait for the reply and let us know what happens either way.

All the best, and best wishes for a prompt recovery.

[Englishbloke]

Bookworm,

Thank you for your really nice response, I appreciate the effort in responding.

Your post is encouraging, I did have a ultrasound scan for the cyst (to check it was a cyst) but as I say they said nothing to worry about and gave me antibiotics. The kind of thing you forget about when you apply for insurance 8 years later!

I can't remember exactly what they asked me on the forms but I tried to be very thorough. I guess as you say it is now a waiting game. If they choose not to pay then I will be (to say the least) gutted! As I assume I will have problems getting critical illness or life cover in the future so if it comes back, I am in trouble!

Back to work now, tired from the chemo but need to pay the bills

Thanks again for your prompt response. Will keep you informed!

[Englishbloke]

UPDATE.

Had a conversation with the insurance company. Apparently they have requested more information from my GP regarding 'testicular pain' so it looks like they spotted what I though they might!

The incident in question involved some pain which I was sent for an ultrasound for, they discovered a cyst for which I was given antibiotics. The problem fixed itself with the antibiotics and never had a problem in the 10 years since. I hope that won't cause an issue with my insurance!?

I have requested a copy of my application form for my piece of mind too.

[Bookworm]

Well, we all knew the moment they spotted something to do with testicles, they were going to ask questions, didn't we?

But in the same way that the fact that you had tonsilitis doesn't mean you'll get throat cancer, the fact that you had a cyst treated with antibiotics 10 yrs ago doesn't mean it is related in any way to your current condition...

The problem here is not whether you had relevant PMH or not, it is that they might use it as an axcuse to say: "ah, but you didn't declare it"... at which point your argument would be, quite rightly, that since you had an acute problem with no repetition since and no relevance to the current issue (apart from its location), then there is no reason fro them to withhold cover.

Worse case scenario and they decline cover, you can ask them for a final decision and take your case to the Ombudsman. Insurances have been under a lot of scrutiny lately about trying to find any which way to wriggle out of paying and ultimately, far too many people accept the inscos decisions without going further.

Let us know what happens, but in the meantime please try and not worry too much. I know it's easier said than done, but try.

[Englishbloke]

UPDATE
Well I just received the copy of my application form that I requested.

The question...in question!? Asks if I have had any x-rays, scans, referrals etc. in the LAST 3 YEARS. The issue they are asking for more info on happened 8 years before my application. So I can't see how they can refuse my claim (as long as the diagnosis my first consultant gave me matches that of the oncologist they have written too!).

I assume they have written for more info on the scan etc. just in case it was cancer that I didn't declare (which it wasn't).

Fingers still crossed. Recovering well (touch wood). Made it up Snowdon 10 days after Chemo which I am quite proud of!

[Bookworm]

I couldn't do it up Snowdon at any time, never mind after nay kind of chemo, so well done to you indeed!

Well, it's looking good, so fingers (and everything else) crossed for you.

[bobbyh99]

Just a quick bit of guidance about your worry about the non disclosure issue.

There are 3 non disclosure elements, set out by the ABI:

Innocent - Claim paid in full
Reckless - Proportionate payment
Fraudulent - Claim declined

From reading your story, it doesn't look like you have much to worry about.

Best of luck
BobbyH

[Englishbloke]

Thanks BobbyH, appreciate your comments, it does look promising but still go a nagging feeling they will dig something up I completely forgot about and claim they would not have provided cover.

Maybe I am being a bit negative? I think I will have a pretty good case to plead if my case does get rejected. I will be sure to hunt for more advice on this forum if they do

[Englishbloke]

UPDATE.
Apparently the claim has now been referred to the underwriters as the claim is large? They said it usually takes 5 days for them to respond with a decision.

[bobbyh99]

Its probably only procedure!
Large CI claims and claims for policies which are <=2 years old will probably go to a Reinsurance company (who assume most of the risk) for a decision!

If you are sure you have not non-disclosed on the application form then you should be OK. If for any reason they do decline the claim, and you are certain about your medical history you can always go to the FOS!

Keep us posted
Best of luck
BobbyH

[Englishbloke]

I guess that is why I am nervous!

Can anyone be CERTAIN about their medical history. I am worried there are little things I can't even remember that they will spot in my medical history. I will certainly fight my case if it is turned down, anything that I have forgotten can't be very serious.

Would recommend anyone taking a new policy actually looks at their own records before filling in any applications.

Thanks for the advice though.

[Englishbloke]

UPDATE
Well it looks like good news! My IFA called yesterday evening and told me that Scot Prov have said they have accepted my claim and will be paying it in full .

Not gonna leap for joy until it is in my account but looks like a positive outcome. Will be recommending Critical Illness cover to all my friends now (amazed how many don't have it).

Thanks for all the advice and support guys!

[bobbyh99]

Thats great news EB.

One of the reasons not many people have it is because its quite an expensive benefit, having said that if you can afford it then its def worth having.

BobbyH

[Englishbloke]

If you take it out young enough it isn't too bad, we paid about 30GBP/month each for almost 200k of cover.

[bobbyh99]

OK I have just a on-line quote for standalone CI only (for me and the missus) and for 200k the cheapest is £124 per month!!

So like you said, perhaps if you are young enough and don't smoke then it can be quite cheap, but alas for me (40 year old smoker) plus my non smoker, younger wife its quite expensive.

Anyway, I truly hope that the operation was a complete success and that it does not return, and also enjoy the £200k when you get it.

Bobbyh

[Bookworm]

and best wishes for a full recovery.