Critical illness stalling from Scot prov

[jacahani]

Hello everyone

In July i was diagnosed with a brain tumour after suffering with really bad head aches and Sickness for 3/4 months before that.

In addition these symptoms i am becoming very forgetful !
Luckily my wife remembered that we had a critical illness policy with scot prov -

I took out two policies with them in 2003 one for me and one for my business - (with four small children, it seemed a sencible precaution)

Obviously now its November and I still don't have an answer from them as to when or if they will pay up. Its really frustrating not knowing if after all I planned, if my family will be or not be covered should the worse happen.

Dose any one here have any experience / knowledge about how these companies work ??

i would be very grateful for any advice / help.

[maroondevo52]

Hello and Welcome, jacahani.

Sorry to hear about the situation you find yourself in, I'm not too clued up on Insurance but I'll move your post to start a new thread in the appropriate Forum, hopefully there, you will get the help and advice you require.

Regards.

Scott.

[Bigmac versus]

Sorry I cant advise you of anything except to check your policy for what is and isnt covered. I just wanted to say Hi and wish you all the best. These situations usually do take a few weeks to be sorted out. What have they said up till now?

[jacahani]

Wow

Thank you both so much for your quick responce.

Big mac

so far they have said very little other than they have been awaiting medical reports.

Most recently they mention discussions with a ' re insurer' what ever that is ????

[jacahani]

Scott.

Thank you,

[Bookworm]

Hi, Jacahani.

Who's your insurance with? Did you get through a broker or are you talking to the insurers direct?

You need to clarify with them what they mean by "re insurer". It may be that your original insco was taken over/merged/bought by another one, and then new policies get written, and when one of the "older" policies kicks in, they have to go find out what terms these do or don't cover.

Regardless of the above, it is not acceptable that you should still be waiting for a response, so you need to take a firmer stance by now (easier said than done in your condition, I know). Something on the lines of "I put in a claim on X date, it has been X weeks and you have failed to let me know the outcome, please let me have a response/update within 7 days"...

If you need any help in writing the letters or working out the terms of your policy, just holler. And all the best.

[jacahani]

Thank you for your help bookworm

The company is scotish provident, i took the policy out with a broker, although they are sending me directly to the ins company.

I will phone the insurance co again and get some clarification, i was nervous to do so in case they took offence and that this may have affected the out come.

Thanks again,

[jacahani]

UPDATE

Just come of the phone to scot prov - as my claim consists of 2 policies

1) personnel - £200,000

2) Key Man ( Business ) - £250,000

The total amount is too much for them, so they have used an insurance company to offset the risk. This is the re-insurer.

They are waiting a decision from them, my frustration now is that I was not informed of this re-insurer. surely the re-insurer decsision is between them and scot -prov and should not effect me. Is that logical ?

[Bookworm]

I know nothing of business insurance policies, I'm sorry, so I am not going to try and guess what that entails. How does it work? What do they each cover? The person, loss of earnings, mortgage?

Anyway, the fact that they chose to get another insco involved is irrelevant to you. Your contract is between them and you and I would suggest that you go ahead with the firm letter, adding in the element that you understand the re-insurer thing, but that it is not your problem, you took an insurance policy with them, a well known household name, which presumably carries a promise to pay promptly in case of claim, and is there any chance of seeing the money before you die of old age, never mind cancer? And I am quite serious, I would use those words. It is just completely outrageous that they should delay so much in the case of a claim under critical illness It's got to the point where if you don't shock them into action, they'll quite happily sit on your claim until the cows come home.

Bottom line is that even if they had been banking with Northern Rock and had their savings invested in Icelandic bonds, that makes no difference to the fact that YOU need that money now, you paid your premiums, and now you are claiming and unless they have a reason to decline cover, then you want that money now. Therefore you need to tell them that you want a decision and you want it within 7 days or you will go to the Ombudsman, as their delays are simply not good enough.

Don't be afraid of "offending them", they have heard far worse and don't give a toss what you think of them anyway. As the saying goes, it's not personal, it's business.

I've got children to take to hospital and stuff today so will be out for most of the day, but I'll keep an eye on your thread as and when, any questions, just holler and I'll answer when I get back. If you need help with the letter, or want to post it on here for comments, no problem.

	The Financial Ombudsman Service For the most part, don't bother. The Ombudsman is an industry arranged service which is under-resourced, takes too long, lacks clear transparency. You have no idea what evidence the FOS has received from the bank or how your complain has really been handled. The FOS is the preferred complaints route for the banking industry. The county court is to be preferred by consumers for its speed, openness, the quality of its awards and also because it will award 8% interest on top of any damages won by you. The Ombudsman should normally be used to solving little technical difficulties or customer service problems which you have expereinced with your bank.

[bobbyh99]

Jacahani

I have PM'd you with the answers.
One other question, when did you make the claim? I know you were diagnosed in July but did you make the claim in July as well?

It might be that the "insurance" company are waiting on medical evidence which has been requested by the "reinsurance" company. Having said that, you should chase the insurance company at least twice weekly!

Just a bit of information. A reinsurance company normally has some agreed service standards with the insurance company with regards to claims. These are between 24 and 48 hours. This means that the reinsurance company has to come back to the insurance company within these limits. This doesn't mean they have to make or have made a decision but they could be requesting more information.

I hope this helps.
BobbyH

[jacahani]

UPDATE

Thank you all so much for your help, it's quite overwhelming from feeling small and insignificant to having a strong and knowledgeable team behind you within 24 hours. Thanks should be given to the CAB for recommending the site. (all be it unoffically)

So this afternoon I spoke very firmly to broker and ins co and got more information than i had recieved for the last five months.

It would seem the ins co were awaiting reports from my doctors which were recieved two weeks ago, last thursday they sent a report to the re - insurers and have been promised a reply by this thursday.

I have been advised that three criteria must be met.

1) Is the diagnosis correct - Yep I even have a picture !
2) was there any undisclosed information on my medical records which would have stopped them insuring me. - No
3) Dose my infliction match the criteria from my policy document - well i suppose thats the bit down to interpretation ?

so my assumption is that the insurance company must have okay'd things and have now sent information to the re- insurance company.

So it seems like things have been progressing alot more than I thought, although it seems a bit rough that when you are at your weakest you must be at your strongest to learn anything !!!!!!!!!!!!?

thank you all again.

[Bookworm]

I have been advised that three criteria must be met.

1) Is the diagnosis correct - Yep I even have a picture ! No offence, but please don't show us!!!
2) was there any undisclosed information on my medical records which would have stopped them insuring me. - No
3) Dose my infliction match the criteria from my policy document - well i suppose thats the bit down to interpretation ? Not according to the ABI themselves, that shouldn't be.
http://www.abi.org.uk/Public/Consume...llness_new.pdf

So it seems like things have been progressing alot more than I thought, although it seems a bit rough that when you are at your weakest you must be at your strongest to learn anything !!!!!!!!!!!!?

I'm sorry to say that in some cases, the least scrupulous insurance companies have it factored in their costs how many of their clients will die before a claim is complete and the relatives are then too distraught/unknowledgeable to carry on with the claim. (allegedly! )

Anyway, please let us know the outcome of your claim, and hope you feel better soon.

[bobbyh99]

I have had a quick look at the critical illnesses covered now for Scot Prov plans on their key features online and it say "Benign Brain Tumour - Resulting in permanent symptoms".

So if this fits you, I can't see how they can decline!

Best of luck
BobbyH

[bobbyh99]

Originally Posted by Bookworm

I'm sorry to say that in some cases, the least scrupulous insurance companies have it factored in their costs how many of their clients will die before a claim is complete and the relatives are then too distraught/unknowledgeable to carry on with the claim. (allegedly! )

Anyway, please let us know the outcome of your claim, and hope you feel better soon.

Bookworm can you elaborate?
After spending most of my adult life pricing these sorts of risks for hundreds of insurance companies, I can honestly say that factoring in costs for this sort of thing doesn't happen!

You would be very surprised to know that most claims are notified to the insurance company very quickly, in a lot of cases the following day!!!

BobbyH

[jacahani]

Well they took there time, but I have had a responce.

It would seem that scot prov are not happy with the definition of the claim.

This was the only element that there could be any doubt. And as you would expect they have done so.

I don't have any thing in writing yet, when I do I'll let you all know.

[Bookworm]

Originally Posted by bobbyh99

You would be very surprised to know that most claims are notified to the insurance company very quickly, in a lot of cases the following day!!!

BobbyH

Having dealt with claims coming in weeks or even months after the event, you're right, I would be very surprised.

[bobbyh99]

Originally Posted by jacahani

Well they took there time, but I have had a responce.

It would seem that scot prov are not happy with the definition of the claim.

This was the only element that there could be any doubt. And as you would expect they have done so.

Jacahani
Can you tell me exactly what you put on the claim form for your illness?
If you have the policy documents, what does it say is covered on them?
If they are not happy with the definition then perhaps your surgeon/doctor has provided them with something else which has made them "not happy"!

BobbyH

[medders]

It is worth speaking to your GP or specialist about what they put on the medical report that they sent to Scot Prov. Your Dr will be able to show you a copy of the report and this may clarify what the problem is. It is worth taking a copy of the critical illness definitions to the Dr's with you and he will then be able to tell you whther you meet the criteria for a pay out.

It is hopefully something simple like your GP not having the full details from your hospital consultant yet so not putting everything on the medical report.

When it comes to medical reports always get your GP involved the insurer should not by law discuss with you directly anything they have received in a medical report it all has to go via your doctor.

Good Luck!!!!

[Englishbloke]

Sorry to hear your claim was rejected. I have recently had a Scot Prov claim approved but my condition was clearly outlined in their documents as being covered.

I would suggest you complain to them first and then go the Obudsman who might be able to help you.

Good luck and I hope your condition improves.

[jacahani]

Thanks everyone for your help and support.

I have the letter now from S P and as indicated the point of argument is wether the criteria is exactly met, I will see my doctor soon and hopefully get a definitive,

Amazing though, I have a brain tumour that is making work impossible and hence finances difficult, five years ago when we decided to have a larger family we took the descision to increase our insurance to protect us and our business. We chose what we thought was the best company with the finiest reputation and yet, when we have to claim, when we are at our weakest and lowest it seem we have to fight tooth and nail to recieve what should be fairly ours. I feel very strongly that these insurances should be black and white and not open to interpretation !!!