Pinnacle Income Replacement Insurance

suecrill · 13th January 2007, 09:55

Can anyone offer me any advice please
My husband has had an income replacement policy with Pinnacle for many years. In July this year he had several heart attacts followed by heart surgery. At the time he was a self employed pulican on a joint lease with myself, however he was the personal licence holder. The business bank account was a joint account. We worked the business together and I also had a full time job. After the other half became ill (and hospitalised), I took over running the business with help from some friends and family. He had no input into the business at all - not even doing the accounts. After a few weeks, it became apparant that he would not be able physically to re commence working in the pub trade for many months, maybe even longer, we made the decision to resign our tenancy (with much regret) as it was too much for me to run on my own and not enough profit to employ anyone. In our tenancy agreement that we had to give 6 months notice to the brewery, I might add that the brewery were very supportive and found new tenants very quickly, however I had to continue keeping the pub open until 12 th December. My husband continued to pay his class 2 NI contributions during this period as advised by our accountant.
We sent a claim form into pinnacle, doctor completed medical evidence then pinnacle wrote to us requesting more info (as i wld have expected) They required bank statements invoices etc. No problem, I sent everything they requested and yesterday received a phone call advising they are declining the claim. They say as we have continued to work the business during aug to dec and there have been (obviously) credits into our bank account, that the claim has been declined.
I was obviously upset by this phone call and the advisor on the phone said she wld get a senior underwriter to call me later in the day.
The senior advisor did ring me and I explained everything about the circumstances. He said he would lodge an appeal for me but couldnt guarantee what the outcome would be. He said that they wld probably write back requesting more information and proof (of what I dont know).
I~ can understand here they are coming from , so I suggested that if it wouldnt be possible to allow the claim while he was still self employed would they at least allow it from when we had to give up the business, they advised that was not possible as it had to paid from the outset of the business or not at all.

I would appreciate any advice anybody could offer me on the way forward with this, as from his tone and manner I fully expect that they will once again deny the claim (I must add however, he was very sympathetic).

Sorry for this being such a long post but we desperately need this money and the uncertainty of our income is making my husband ill.

Regards and thank you so much in anticipation
Sue

suecrill · 13th January 2007, 18:30

please can anybody give me any advice thanks sue

reidnet · 13th January 2007, 19:40

Hi Sue,
To be Honest I am not too sure the Ins and Outs of these Income Replacement Policies.

I pressume you made a claim as soon as your Husband was Hospitalised ?,

I will PM you the names of a couple of folk on here who I think may be able to help you with this one.

Ian

suecrill · 13th January 2007, 19:45

Thanks Ian
No I didn't make the claim right away - too much personal stress at the time was just so unexpected - however I did make the claim as soon as I remembered he had the policy in force - but was in november. They have not disputed the time lapse in making the claim - just the fact that the bank account was still active and credits being paid in
thanks again
sue

reidnet · 13th January 2007, 19:59

Quote:

Originally Posted by suecrill

Thanks Ian
No I didn't make the claim right away - too much personal stress at the time was just so unexpected - however I did make the claim as soon as I remembered he had the policy in force - but was in november. They have not disputed the time lapse in making the claim - just the fact that the bank account was still active and credits being paid in
thanks again
sue

Yes but it is a Joint bank account so they could expect payments to be goin in there

Ian

suecrill · 13th January 2007, 20:04

Hi Ian
yes it is a joint account and the tenancy agreement was in joint names - since he had his first heart attack end july he has been unable to work at all he had 11 heart attacks then heart surgery, the prognosis is good, however he will not be able to return to work in the pub trade or his previous employment as a lorry driver.
I ran the pub in the evening and our family helped throught the day he couldnt even do the accounts as the doc said would cause him too much stress
thanks
sue

Nightmare4banks · 14th January 2007, 04:28

Hi all!

Suecrill in reply to your post and PM:

To begin with I am very sorry to read about your husband's health problems and hope he continues to get better.

Anyway,let's se how we can help you here.

In order to possibly help you out I would need the written response of the refusal with reasons from Pinnacle word by word or you send a copy/copies of the letter/s to me to me to my e-mail address which I will PM you.

ALSO.....

Never believe anyone is sympathetic all they care about is lining their pockets and I am talking about the industry as a whole.

Anyway,enough of me ranting.

After I receive the letter from you I will give you my general view and backed up woith suggestions of the way forward.

FINALLY...
Do not worry as you are not alone on this forum.

Nightmare4banks · 14th January 2007, 04:29

Hi all!

Suecrill in reply to your post and PM:

To begin with I am very sorry to read about your husband's health problems and hope he continues to get better.

Anyway,let's se how we can help you here.

In order to possibly help you out I would need the written response of the refusal with reasons from Pinnacle word by word or you send a copy/copies of the letter/s to me to me to my e-mail address which I will PM you.

ALSO.....

Never believe anyone is sympathetic all they care about is lining their pockets and I am talking about the industry as a whole.

Anyway,enough of me ranting.

After I receive the letter from you I will give you my general view and backed up with suggestions/ideas regarding the way forward.

FINALLY...

Do not worry as you are not alone on this forum.

Nightmare4banks · 14th January 2007, 04:36

Suecrill,

I have just PMed you my e-mail address.

suecrill · 14th January 2007, 11:31

Hi
Thanks for replying. As soon as the letter arrives in the post I will e mail it to you. They read the letter to me over the phone on friday I have not received it yet. Thank you so much for your time.
regards
sue

reidnet · 14th January 2007, 16:51

Hi Nightmare4banks,

Hope you dont mind that I passed your name onto Sue.. I know you helped me in the past too. Thanks for getting back so quick for Sue too.

Ian

Pezboy · 14th January 2007, 23:27

Hi Sue/Ian

I've had a quick read of the thread, and being honest, it really doesnt look like Pinnacle themselves know why they have declined the claim!

The fact the accounts are active and recieving credits have nothing to do with the claim itself, and should certainly not be affecting the claim outcome.

To add a little info, my partner is currently of sick with depression. She has a docters note, signed dated and a medical report written. We sent this to our lender (HSBC) where within 3 days they had authorised the claim.

Bear in mind the account is still very much active, and we are both being paid our normal salerys into it.

What I suggest is that you get the whole decline put in writting, and then take that to the OFT, or, if pinnacle are simply the underwriters for your bank, speak to your bank directly.

If you have any questions regarding the ins and outs of the policy, and you can show me a copy online (Or eMail it to me) I'll happily advise as much as I can.

-J

suecrill · 15th January 2007, 12:13

Hi
The letter recieved from Pinnacle states the following:

Dear Mr XXXXXX

Income Replacement Plan
Policy Number XXXXXXX
Claim Number XXXXXXXX

I write with reference to the above claim.

Unfortunately, I am not in a position to accept this claim for the reasons stated below:

Please be advised that you were still earning whilst being off sick.

I am sorry that I have been unable to be of assistance on this occasion. Should you disagree with my decision you may appeal to our Senior Administrator, who will review your claim in line with our internal appeals procedure. Please ensure that any evidence you have to support your appeal is made available for consideration.

Yours sicerely

Nicola Lampey
Claims Department

This decision has been made from the documents i sent to them, ie bank statements in joint names from Business Account, medical evidence, supporting letter outlining what I said in the first thread on this post, accountants name, etc.

Any advice gratefully received.

Many thanks to everyone trying to help me
Sue

suecrill · 15th January 2007, 13:00

Hi Pezboy
Thanks for your response, I have requested copy policy docs from Pinnacle who advise 5 working days for them to send. On receipt, I will pm you for your e mail addy. Thank you so m uch for taking the time to have a look at my problem.

thanks again
sue

mooreda · 15th January 2007, 18:07

Oh my god - another insurer trying to riggle out of paying - that letter of repudiation of your claim is appalling. In order to take the matter further, I suggest you write the following letter in response:-

Dear Sir/Madam

Complaint regarding Claim Number X123456

I refer to your correspondence dated 1st January 2006.

You have refused to deal with my husband's claim on the assumption that he was in receipt of earnings whilst he was unfit for work - this is NOT the case as it was myself who continued to work - not my husband.

Please explain, IN FULL, why you are unable to be of any financial assistance on this occasion and provide details of the specific exclusion in the terms and conditions policy upon where your decision has been made.

I trust your response will be that on behalf of your Chief Executive as I intend to take the matter further to the Financial Ombudsman Service if you remain of the view that you are unable to deal with my claim.

reidnet · 15th January 2007, 18:49

Nice reply Mooreda.. Im sure that will get the wind up them...

Good Luck Sue..

Ian

Pezboy · 15th January 2007, 19:33

Quote:

Originally Posted by mooreda

Oh my god - another insurer trying to riggle out of paying - that letter of repudiation of your claim is appalling. In order to take the matter further, I suggest you write the following letter in response:-

Dear Sir/Madam

Complaint regarding Claim Number X123456

I refer to your correspondence dated 1st January 2006.

You have refused to deal with my husband's claim on the assumption that he was in receipt of earnings whilst he was unfit for work - this is NOT the case as it was myself who continued to work - not my husband.

Please explain, IN FULL, why you are unable to

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