Thread: Help with critical illness claim

Thanks for the support

I've asked for a copy of the policy, so will wait until that comes through. I don't like the bit where it says "With regards to your request for a copy of the policy document, unfortunately I am not in the position to send you an accurate version at the present time. I will be more than happy to send this to you once Unum have issued an accurate document, which we have had the opportunity to check.

What the hell are they doing selling insurance that they don't have the details of?

Mrs W is doing much better, look like she's going to make a 99% recovery. the day after it happened she was blind in one eye and unable to walk. Thinking this is the way it's going stay I was in shock and we have three kids the stress was massive but at Least she was insured

Clear case of miss selling, I'll keep you all informed of my progress. Going to fight this one all the way. The twist in the tale is this.

I phoned Unum on Friday ( to go mad) and they said my claim was progressing, did the broker make a mistake and unintentionally sell me spouse cover?

Unum and the broker still can't get there story stright

Why don't you ask UNUM for the accounting documentation. This has to detail (on a yearly basis), everone who is covered under the scheme! I presume this would be covered under SAR!

5.1 What information is required for policy accounting purposes?

At the commencement date and at each policy accounting date, a list of all members will be required showing for each member:

• name, date of birth, gender, salary, sum assured, spouse's benefit (if applicable), date of joining or date of leaving (if applicable).

We will need individual information for any employees whose benefits exceed the AEL or who are joining outside the normal eligibility conditions.
Details of new entrants will be required at the time of joining. It is therefore preferable to receive monthly membership data to ensure the policy accounting is as up to date as possible.
5.2 How are accounts adjusted for members who join, leave or have benefit increases during the year?

If a member's earnings increase, this will normally be reflected in the benefit, provided it remains below the AEL.
Where requested, increases in benefit arising from salary increases during the policy accounting period can be covered automatically. This will require monthly membership data and premium billing. If a member's benefit exceeds the AEL, satisfactory evidence of health will be needed before Unum can consider the increase.
Details of new entrants will be required at the time of joining.

The above is from UNUM's website for Voluntary CI.

BobbyH

Thank you for your help bobbyh99, I 've asked UNUM for the policy documents and Any supporting documents here's their response:


Thank you for your E-mail.

As previously discussed a policy document had not been issued as yet for this scheme therefore I have passed this request onto our Policy Production Team.

They have advised me that unfortunately Unum are not able to issue copies of the policy document to members of our schemes. Since this is a group policy the terms of insurance is held between your employer and Unum therefore we are only able to send copies to brokers or the clients themselves.

To my knowledge the broker for this scheme should now have a copy of the policy document, consequently if you require sight of this I would respectfully suggest to obtain this from your employer.

Apologies I could not be of any further assistance in this matter.

Kind regards



I've ask orbit for the policy documents as well. (see above) should i SAR them?

From commencement date of the Group policy plus at regular intervals (i.e. quartely) your employer has to give a list of the members of the group scheme to UNUM! On this list, will have whether or not any spouse's benefit has been applied.

As this is a Group policy, have you asked your employer for this list? or are you the employer?

Reading between the lines, as UNUM say you claim is progressing, this might mean that they are happy about the spouse's benefit but are underwriting the claim on medical grounds (i.e. your partners stroke).

If your employer has provided this scheme list to UNUM, then UNUM will know very quickly whether there is a spouse's benefit!!

If there wasn't any spouse's benefit on the list, UNUM would have declined this very quickly.

I would keep nudging UNUM and get the list from employers.

BobbyH

Originally Posted by master woody

UNUM have requested from orbit an updated membership list, which orbit have given them. The list didn't contain any spouse information because they didn't intend to sell spouse cover....

Forgive me if I am wrong, but its UNUM that sell the policy and provide the benefits. My post previously when I stated the sections 5.1 etc came directly from UNUM's website. The part you quoted in your first post came from Orbit's website but the wording is exactly the same as UNUM's. UNUM have agreed you partner is covered, they have also agreed that the premiums/costings are correct for the spouse's cover.

Orbit Benefits Limited are allowing you to choose your own benefits using their software and are marketing UNUM's Voluntary Group CI cover! If the spouse's cover option was not available on their website, how did you manage to get spouse's cover? Or were you just assuming that spouse's cover was included?

"Our findings confirm our position that Spouse/Partner Critical Illness cover has never been included as a MY COMPANY FlexIT enefit option and has therefore never been an election option on the website."

Do you think UNUM might pay without this information? I've past on my marriage certificate

They might do!!

BobbyH

Forgive me if I am wrong, but its UNUM that sell the policy and provide the benefits.

I'm thinking that UNUM is the insurer and orbit was the broker. I might be wrong. If things go wrong i was going to go after orbit for mis- selling? orbit was the point of sale

Orbit Benefits Limited are allowing you to choose your own benefits using their software and are marketing UNUM's Voluntary Group CI cover!

Thats right, so is orbit the broker?

Or were you just assuming that spouse's cover was included?

Well no not assuming, You couldn't choose to add the spouse cover, but in the "further details screen" it said your children are automatically covered and spouse cover was optional. I was confused so I phoned the orbit help line and they said go direct to UNUM . I phoned UNUM and they said Spouse cover was included automatically

If they are marketing UNUM's policy then they should offer everything associated with that policy. I wonder if UNUM know Orbit are not allowing the spouse's cover option on their website!!

They are an intermediary, go-between for you and your Insurance company (UNUM).

Bobby thank you for your help, i'll try and find out

Who's the guest?

Reponce to my request for the policy documents and costing information.

Further to Chris xxxxxxxxxx response dated 4th March regarding your complaint and your subsequent email of the 9th March, I am writing to confirm that Chris is dealing with your request and has been chasing Unum. We are awaiting the corrected policy document from them, due to their withdrawal of the original because of an error. When the correct policy document is to hand, a copy will be sent to you with the prior consent of your employer, who is the policyholder.



In the meantime, you have requested a copy of our complaints procedure which I attach herewith. Please be assured that we have investigated this matter fully and the response from Chris on 4th March was the culmination of those enquiries. We have suggested that your complaint should be directed at UNUM, but if you feel that we have not dealt with your complaint to your satisfaction, you may be eligible to take your complaint to the Financial Ombudsman Service and I attach a scanned copy of their leaflet 'your complaint and the ombudsman'. Should you wish to take your complaint against Bluefin to the fos please be advised that you will need to do so within 6 months of the date of this email.



Please do not hesitate to contact me if you have any further queries.

I am not sure a policy document will tell you anymore than you already know! What you need is the scheme members list, which will include you and your benefit and also that of the spouse's benefit!!

Have you employers confirmed that you have spouse's benefit?

BobbyH

Originally Posted by bobbyh99

I am not sure a policy document will tell you anymore than you already know! What you need is the scheme members list, which will include you and your benefit and also that of the spouse's benefit!!

Have you employers confirmed that you have spouse's benefit?

BobbyH

Bobby

My company and orbit has said there IS NO Spouse benifit. I'm the only one on the list (and my co workers)

UNUM have said, oh yes Spouse IS included, but your company hasn't passed on a completed list of members.

Orbit say the list is complete.......so i'm stuck in the middle

UNUM are still processing the claim

Hi all I've received an email from orbit, not sure what my next move is ?????

Dear xxxxxxxxxxxxxxxxxx

Further to your email of 13th March 2009, I now have the opportunity to respond to your enquiries. Firstly we need to clarify that it is at your employer’s discretion whether you have access to policy documentation or not. However, I can confirm that we have obtained the required authorisation from Hewlett Packard to release a copy of the policy document and its attaching conditions in connection with the Voluntary Critical Illness Cover benefit about which you complain. I hope that the enclosed information is of assistance to you.

You also requested sight of the policy document that “orbit was working with at the time of the sale.” I can confirm that there is no such document – nor is there any requirement for there to be. terms and conditions of a required benefit package or individual policy are discussed and the final “package” is one that is tailored to meet a client’s specific requirements. As XXXXXXXX explained previously, the benefit you are trying to claim through Unum has never been insured by Unum, offered as an elective through the Orbit website, nor was it your employer’s intention to offer it as one. You may wish to clarify this issue with your employer if you so wish.

I would add that after the policy commenced, UNUM delayed in issuing your employer’s policy document. We received this on 19th February 2009 but an error was spotted. This has now been rectified. Unum has apologised to your employer for the severe delay in issuing this document.

This has had no bearing on the terms and conditions at the commencement of the policy nor has it had any influence on the outcome of your claim.

We are of course mindful of the anxiety that this has no doubt placed on you following your wife’s unfortunate illness and whilst we are indeed sympathetic to this we can only reiterate XXXXXXXXX earlier suggestion that you approach UNUM directly to further your claim. We would be happy to assist you with this and can facilitate a request to Unum’s senior management to consider your claim on a discretionary basis. Please let us know whether this is something you wish us to commence.

I trust this is satisfactory; however, please feel free to contact us if we can assist further.

Originally Posted by master woody

As XXXXXXXX explained previously, the benefit you are trying to claim through Unum has never been insured by Unum, offered as an elective through the Orbit website, nor was it your employer’s intention to offer it as one. You may wish to clarify this issue with your employer if you so wish.

This is a complete load of tosh.
My previous post on the 20 March came directly from Unum's website for their Voluntary CI policy. Also what about the fact that Unum have written to you and confirmed your spouse's benefit??

BobbyH