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My email

 

Dear Chris

 

As per our telephone conversation this afternoon, you requested an email giving a brief outline of events.

 

Mid January. I made a claim on my critical illness cover, scheme number 0371101 sold to me via the orbit flex it scheme provided by Unum, after my 36 year old wife suffered a stroke.

 

I have been informed by Justine xxxxx the compensation and benefits manager for my company (company name) that there may be a problem with the claim. Orbit (bluefin) have been unable to pass over a “Membership list” and because of this may claim may fail.

 

I have a letter form Unum dated the 3 February 2009 that, and I quote verbatim “We note from our records that spouses benefit is insured under the terms and conditions of the policy, however we do not appear to have received membership data that states the level of cover spouse’s are insured for.”

 

In April 2008 I used my flex option do down grade my Critical Illness cover to £75,000 at this time I took the opportunity to read all the available information in the Orbit flex it system regarding this policy.

 

In the “technical guide” section 1.6.1 states the spousal cover is an option on both base and extra cover, but no option is given in the flex it area to add this. However other benefits in the flex it system clearly state who is covered for example health care. I found this very ambiguous and confusing. So I rang your “helpline”. I was advised to contact the insurer (Unum) directly, for confirmation, I phoned Unum and they informed me that my spouse is covered in the terms and conditions of the policy. These ties in with the letter date 3 February from Unum.

 

 

I have taken every reasonable effort on my part to ensure I was being sold the correct policy for my requirements. If it was made clear at the time my spouse was not cover I would have made alternative agreements.

 

I have contacted Matthew xxxx from Unum today and he informs the claim is still progressing? It seems even at this stage Orbit (Bluefin) and Unum are unable to give me a coherent answers.

This matter will be vigorously pursued.

Regards

 

Responce 1

Dear Mr woody

 

Further to your email of 11th February, addressed to my colleague Chris xxxxx, I am writing to acknowledge receipt of your complaint, which has been passed to the Compliance Department, of which I am a member, to investigate. I am sorry to hear you are dissatisfied with the service we have provided.

 

Please be assured we will examine this matter fully, writing to inform you of the outcome of our investigation in due course. Should you have any further questions in the meantime, please do not hesitate to contact me on the email address below.

 

Yours sincerely

 

 

Linda jjjjjjjjjj

 

Responce 2

 

Dear master woody

 

I refer to the claim you submitted to Unum under the MY COMPAY Voluntary Critical Illness scheme (policy 0371101) and also your subsequent complaint to us further to a conflict in information that was provided by Orbit and Unum in terms of the insurance cover provided.

 

I referred the matter immediately to our central Compliance Department who have been investigating the issue.

 

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.

 

Unum have also confirmed that they have never received instruction from us to provide this cover.

 

If you feel you were misled by Unum, you may wish to pursue the matter directly with them. You can write directly to them at the following address outlining your complaint. We recommend that you quote the scheme name Voluntary Critical Illness scheme” and the scheme number “0371101” in any communications.

 

Head of Customer Feedback

Unum

Milton Court

Dorking

Surrey

RH4 3LZ

 

Tel: 01306 hhhhhhhh

 

If the matter remains unresolved, you may be eligible to contact the Financial Ombudsman Service. Your legal rights are not affected if you contact this organisation.

 

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.

 

I appreciate that this is a particularly difficult time for you at present and hope your wife is making a good recovery.

 

I hope this information is useful to you; however, please feel free to contact me if I can be of further assistance.

 

Edited by caro
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So sorry to hear about Mrs W. For info I have a friend who had a stroke in her twenties and made a full recovery. She went on to have 2 boys, both now grown up, so although this is obviously devastating for you both now, it may not be so bad as you think in the long term.

 

I assume are some kind of broker? What do they have to say for themselves? Get a copy of the policy from them.

 

What outcome are you looking for from this? I assume you want the income you thought you'd covered your family for, or is this a mis-selling issue? The fact that they said your wife is covered puts them at fault I would think, so I suggest you press your complaint with them in writing. Warn them that you will take the matter further either to FOS or via the court if you don't get a satisfactory response within 14 days. They can take it up with the insurance company if they believe they were misled.

Edited by caro
reread original post and corrected my post
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Should you be offered help that requires payment please report it to site team.

Advice & opinions given by Caro are personal, are not endorsed by Consumer Action Group or Bank Action Group, and are offered informally, without prejudice & without liability. Your decisions and actions are your own, and should you be in any doubt, you are advised to seek the opinion of a qualified professional.

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Shocking.

Unum has been in the news quite a lot.

Have a look what the BBC uncovered.

 

BBC - Search results for welfare rogue

Have a happy and prosperous 2013 by avoiiding Payday loans. If you are sent a private message directing you for advice or support with your issues to another website,this is your choice.Before you decide,consider the users here who have already offered help and support.

Advice offered by Martin3030 is not supported by any legal training or qualification.Members are advised to use the services of fully insured legal professionals when needed.

 

 

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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 :mad:

 

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

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If they cant supply an accurate version then its not even worth them bothering.

Where did these people go to school ?

Have a happy and prosperous 2013 by avoiiding Payday loans. If you are sent a private message directing you for advice or support with your issues to another website,this is your choice.Before you decide,consider the users here who have already offered help and support.

Advice offered by Martin3030 is not supported by any legal training or qualification.Members are advised to use the services of fully insured legal professionals when needed.

 

 

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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

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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?

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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

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Bobby

 

This is the crux of the issue, UNUM are saying YES we did have spouse covered, they looked at the costing information and the spouse's cover was costed in. and told me to make a claim

 

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....

 

Orbit (part of the blue fin group) is a company which provide large company's a flexible benefits system ie it partly out-sources the HR department. Orbit control my pension and benefits. CI was optional and i paid straight out of wages for it.

 

All orbit have to do is provide the spouse information on and UNUM would be happy. But there refusing too

 

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

Edited by master woody
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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

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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

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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).

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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.

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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

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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

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  • 2 weeks later...

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.

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What has your employer said about all this? I can't think why they should take money from you for an insurance policy, and then not let you see what they're paying for.

 

I think you should take up the offer of looking into discretionary payment, but make it quite clear that you still believe you had been paying for this cover anyway.

 

If this is a genuine offer to sort matters, that's good, but I'd be careful to make sure that there are no strings attached to any settlement. One concern I would have is that now your wife has suffered this illness, she may find it difficult, if not impossible, to get insurance cover in the future. As this was not a pre-existing condition, I imagine they would be obliged to continue cover, but you don't want to be bought off with a one-off discretionary payment, so tread carefully.

The Consumer Action Group is a free help site.

Should you be offered help that requires payment please report it to site team.

Advice & opinions given by Caro are personal, are not endorsed by Consumer Action Group or Bank Action Group, and are offered informally, without prejudice & without liability. Your decisions and actions are your own, and should you be in any doubt, you are advised to seek the opinion of a qualified professional.

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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

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  • 1 month later...

Can't believe this......sent an email to Unum asking where my claims up to, they said they had sent there decision to my employer on the 8 APRIL 2009. (My employer has sat on the letter until I call them today)

It’s been refused on medical grounds, as my wife hasn’t suffered permanent symptoms. BUT she has !!!!

Of cause I’m going to appeal!

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Incredible. Don't your HR department have any idea how stressful this must be for you and your family.:mad:

 

Does your post imply that your wife is actually covered by the policy, but only for permanent disability? Have you managed to see a copy of the policy yet and what's covered?

The Consumer Action Group is a free help site.

Should you be offered help that requires payment please report it to site team.

Advice & opinions given by Caro are personal, are not endorsed by Consumer Action Group or Bank Action Group, and are offered informally, without prejudice & without liability. Your decisions and actions are your own, and should you be in any doubt, you are advised to seek the opinion of a qualified professional.

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The Stroke definnition is based on the ABI guidelines (according to Unum's website). This definition is:

 

Stroke.

 

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms.

 

For the above definition, the following is not covered:

  • Transient ischaemic attack.
  • Traumatic injury to brain tissue or blood vessels.

If this applies to your wife's case then appeal.

 

Good luck

BobbyH

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  • 1 month later...

I've had a reply from orbit ( AKA bluefin) the broker in this case which reads..

 

Dear Mr woody

 

Thank you for your e-mail.

 

As you are aware from our previous correspondence, the benefit you are

trying to claim through Unum has never been insured by them so we were

concerned to receive your email dated 8th May stating that "UNUM have

confirmed that spousal cover is included on policy".

 

We have contacted UNUM for an explanation and have now received a letter

(copy attached) which helps to explain what has arisen here. It

confirms that our summary to you was correct; no spousal cover is

insured and Unum has made an error by saying that your wife was covered.

 

Unum has only agreed to look at your claim because of this lack of

clarity when first approached and also because of Bluefin's influence in

this matter.

 

We understand that the claim has been declined for medical reasons. Your

final option is to appeal against the decision made by Unum because you

feel your wife's condition meets one of the definitions in their policy

conditions. Your email suggests that you have already started this

process.

 

I trust this addresses your concerns with the summary provided by

Bluefin; we were not inaccurate and have used our influence to help

during this difficult time. If you feel we can assist you with your

appeal to Unum, please feel free to contact us.

 

I am in fact try to appeal, and we see how this goses. 6 months on and i'm still battling!

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The Consumer Action Group is a free help site.

Should you be offered help that requires payment please report it to site team.

Advice & opinions given by Caro are personal, are not endorsed by Consumer Action Group or Bank Action Group, and are offered informally, without prejudice & without liability. Your decisions and actions are your own, and should you be in any doubt, you are advised to seek the opinion of a qualified professional.

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