Patricia Pearl - Small Claims Procedure - A Practical Guide


An excellent guide for the layperson in how to use the County Court - a must if you are intending to start a claim.

£19.99 + £1.50 (P&P)

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  1. #1
    Basic Account Holder billchurchill Novitiate

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    Default Critical Illness - Legal and General

    Anyone had any experience of non payment of a critical illness claim?? L & G are refusing to pay out to me - I claimed as I have been diagnosed with an invasive and aggressive cancer which does constitute a critical illness. Having scrutinised my medical records they now say my policy is null and void as I omitted to declare a viral illness on my original application form. If I had declared this viral ear infection they would not have insured me in the first place yet they acknowledge that viral labrynthitis is NOT a critical illness. I did not disclose this viral illness as the Financial Adviser who sold me the policy advised me that viral illnesses where irrelevant! I am now in process of taking it to the Financial Ombudsmanicon. Any experience/advice welcome please.

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  2. #2
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    Default Re: Critical Illness - Legal and General

    This makes me so mad. That is exactly the kind of wriggling around that gives insurances such a bad name.

    At a time like this, the last thing you should have to worry about is this kind of trivia.

    Was the financial adviser from L&G or was he a broker? I assume this was done over the phone?

    The way I see it, you have 2 possible responses:
    - You can go after the broker. It should be obvious that if you'd been told about viral infections, of course, you wuld have declared it, therefore, if you didn't, it must be because you were told not to. Their word against yours, it could be tricky,but in the end, it would come down to balance of probabilities. Effectively, were you mis-soldicon a product, whether purposely or not?

    - You keep at L&G. They are now saying that if they'd known about the viral infection, they wouldn't have covered you. Hmmm...

    Causes of labyrinthitis include:
    • Viral or bacterial infection–this is the most common cause
    • Head injury
    • Tumor in the brain or head
    • Disease of blood vessels
    I suspect that the part I have highlighted is the reason they are beign skittish... However, if you have medical evidence that you had viral labyrinthitis, I fail to see how they can use that as an escape clause. Except of course, they are not even saying that, they are using the "well,you didn't tell us everything, therefore, we couldn't make the right risk assessment, therefore, it is all your fault if we say no, and yah boo sucks"...

    I think at this stage, the Ombudsmanicon is your best bet. The insurance Ombudsman is usually quite good. Let us know how you get on, if you need help in drafting a letter, let us know here.

    All my very warm wishes for your well-being to you.

    Just passing through, don't mind me...!
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  3. #3
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    Default Re: Critical Illness - Legal and General

    HI BIll
    Sorry you have been left in this position.
    Yet again another company taking advantage.
    Hopefully the forum can start to help people make a difference.
    Stay in touch keep us updated.
    and good luck with your claim

    BL x


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    Default Re: Critical Illness - Legal and General

    My support is also here.

    Any help needed please post here and we'll do what can.

    Good luck

    Pete

    I will not make any deals with you. I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own. Number 6
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    Default Re: Critical Illness - Legal and General

    Your case has been bugging me, I've ben thinking about it on and off all day.

    Is there any way a friend of yours could get a quote for the same policy, with more or less the same profile as yours, and more or less the same meidcal history? But, most importantly, get him to declare viral labyrinthitis. If they turn him down, then your only hope wil be to go after the broker/mis-soldicon policy angle.
    If they accept him, you will then have positive proof that they're using that as an excuse to wriggle out of paying.

    If th

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    Default Re: Critical Illness - Legal and General

    Bookworm - This also drives me mad and trust me I have seen a lot of it over the past few years.

    Bill - I have just sent you a PM


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    Default Re: Critical Illness - Legal and General

    Have you tried writing to your MP and Watchdog (I think they successfully resolved a similar case recently). Also ask your consultant and GP to write to L&G to support your case. Best wishes


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    Basic Account Holder Resoli Novitiate

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    Default Re: Critical Illness - Legal and General

    Hold on one second here before taking this anywhere near the fosicon with a view to blaming the broker?

    Bookworm - you are out of order suggesting that this should go down the 'mis-soldicon angle'. Do you know that the advisor will be charged by the FOS just because this claim has gone to the FOS? Don't just think that IFAs are a free lunch. Where do you think the adminicon costs for a claim come from?

    The advisor may have said that ''viral infections are irrelevant'' however the burden is on you - the policy holder - to declare any illness and it is for the insurance company to decide what is and what is not relevant. You should have declared it. And even if the advisor has said that - you - the applicant will have had to fill out and sign those forms. You omited what could be a crucial, and has now been proved to be, detail.

    Harsh, but true.


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    Default Re: Critical Illness - Legal and General

    Resoli - Care to elaborate on how I am "out of order"?

    If the advisor specifically told his client he didn't have to declare the viral illness as it was irrelevant when it was in fact extremely relevant and the policy was therefore not suitable, leading to cover being declined then he, the advisor, has mis-soldicon a product and should be held accountable. So he will get charged for being investigated? and? Maybe next time, he'll care more about the suitability of the product he is selling than about pocketing his commission?

    As for saying "Don't just think that IFAs are a free lunch", may I remind you that we are talking about someone with an invasive and agressive cancer here, who, instead of having the peace of mind he thought he was purchasing, is now having to fight an insurance company as well as his cancer. So free lunch, it ain't. I am 100% certain that any of us in those circumstances would gladly not see a penny of the insurance and not having to worry about the disease.

    I have now lost both my parents to cancer, and I find your comments offensive.

    If you can not offer any constructive help to this thread, and only came here to fling mud, then please don't.

    Just passing through, don't mind me...!
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    Default Re: Critical Illness - Legal and General

    Here here booky!
    Where do these people get off sticking up for insurance companies and brokers alike?
    I've yet to see a poor one!
    Of course he should be brought to book, saying something is irrelevant when it clearly is not is diabolical!
    My best wishes to you Bill xx

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    Unfortunately i'm not an expert in any given field legally and my advice and that of the Consumer Action Group and the Bank Action Group is given without prejudice and without liability so please if in any doubt whatsoever seek help from an insured qualified professional. Contents of my posts are purely my own personal opinions and not condoned or endorsed in any way, shape or form by CAG. Thank you!


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    Default Re: Critical Illness - Legal and General

    So according to Resoli, if I had influenza when I was sitting in front of the financial advisor, didn't tell him, took the policy out, and then got a brain tumour a year later, I would not be entitled to claim a thing, as I didn't declare that I had a virus at the time...?

    :P Don't think so somehow...

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  12. #12
    Basic Account Holder Resoli Novitiate

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    Default Re: Critical Illness - Legal and General

    "Maybe next time, he'll care more about the suitability of the product he is selling than about pocketing his commission?"

    If I had a 1 for everytime I heard that one... Are we sure the advisor got commission for this policy? Was there a fee paid instead? Was the fee offset with the commission? In any case the advisor, if independent, big-if, is duty bound to find the best cover possible for the client. Did Bill recieve several quotes? Did Bill give the advisor specific guidelines?

    That can include going to the client had saying policy XYZ has all the 'bells and whistles' but costs more... client replies - I can't afford that ... advisor goes well there is this policy but isn't as good and doesn't cover as much but is cheaper... client agrees he/she needs some cover and this is the best they can afford. So... how has the advisor done the client wrong here? And this is the case in the majority of applications.

    Coming back to the independent point - people needing advise should see an independent advisor. Not a tied advisor. Not a bank's advisor. Not a call centre. Only by seeing someone who is independent, the technical term being whole of market and must provide a fee paying option, can you ensure bias free and best advise.

    " So according to Resoli, if I had influenza when I was sitting in front of the financial advisor, didn't tell him, took the policy out, and then got a brain tumour a year later, I would not be entitled to claim a thing, as I didn't declare that I had a virus at the time...? :P Don't think so somehow..."

    That isn't the case here - there has been a virus that has been linked to a serious illness later down the line. If in doubt the illness should have been declared. It is for the insurance company to decide what is and what is not relevant information. Same principle with house buildings insurance. If you had a structural crack and didn't tell the insurers and then some rendering or a brick or whatever fell off, you'd expect the insurer to say you should have told us. That is a major issue.

    "Don't just think that IFAs are a free lunch"

    The point was that you haven't thought through the consequences on the advisor. You are right in saying this strain isn't needed in the circumstances. Anyone can see that. The fosicon is there to help people - it's remit specifically includes looking at what is fair to the client / consumer given the circumstances. What the FOS doesn't do is look at what is fair to the advisor though. That is my point.

    " Where do these people get off sticking up for insurance companies and brokers alike? I've yet to see a poor one!"

    Look harder then. In particular have a look at the IFA Defence Union. Google it.

    Thousands - literally - of small independent advisors have gone out of business in recent years. What's more is even if the advisor in question has retired, left the business and shut up shop, the FOS still deem him/ her liable, and they still could be asked to stump up. Hardly fair is it?! Ten years later after a policy sale and into your retirement you get a letter demanding cash - even if the advsior has been found to not have done anything wrong.


    If Bill does not have an advisor at the moment he should get one. If anything he should go to them before the FOS and explain the circumstances. Any advisor with decency will fight L&G for Bill, most probably on a pro bono basis. I've done the same (NPI Pension scheme, previous broker completely incompetant failed on half a dozen points. Situation resolved without need for FOS. Client sorted. Client happy.), different circumstances in this case.

    Just simply saying, ''oh advisors are rich, they can pay'' is a total myth. But what there is out there are advisors that actually care about providing good, unbiased advice to clients. There is a dedicated band of advisors that do pro bono work to fix client problems caused by other brokers. Bill should contact one of these. His most local is probably be a small one man band firm who can give his case the time and effort needed.

    As for advice for Bill:

    Did Bill go for a medical or where his medical records requested by L&G? Key issue here because the depth L&G went into assessing Bill's health prior to taking out the policy will dictate the standard of cover he recieved. Minimum basic cover - no medical only application and self declarations.

    But if L&G did undertake a medical and if then they decided to give cover then you've got them bang to rights because they will have known about the illness.

    And yeah, if you hadn't guessed I am an IFA and I can see both sides of this. I've seen the strain small IFA firms are under. I've also seen insurance companies do anything to avoid a pay out. So, Cillitbanger, that's where I get off sticking up for brokers. I am one.


  13. #13
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    Default Re: Critical Illness - Legal and General

    Quote Originally Posted by Resoli View Post
    That isn't the case here - there has been a virus that has been linked to a serious illness later down the line. If in doubt the illness should have been declared. It is for the insurance company to decide what is and what is not relevant information.
    Precisely. So the broker had no right saying to his client that viral illnesses were irrelevant, and proceeding to sell him a policy where they were extremely relevant.

    What the broker, if in doubt, should have done, is contact the insco, and double-check. Insco says: "yes, no problems", broker has done his job right, everyone is happy. Insco says: "yes, but with exclusions for x and y conditions, should they develop in the future", broker has done his job right, everyone is happy. Insco says: "Nope, no dice", back to the drawing board and find another insco that will take on the associated risk, maybe at higher cost.

    Don't get me wrong, I still think that the insco is the first port of call, as I think they are playing fast and loose with the policy wording, not an unusual occurrence, sadly. But I also think that OP should in any case make a complaint against the broker, because, like it or not, the broker did not do his job properly if he sold a product where he stated somehing didn't matter when it did. Turn it any which way you like, that's how it works. It may well be that the Ombudsman would disagree, but in my experience, they wouldn't on something like this.

    Same principle with house buildings insurance. If you had a structural crack and didn't tell the insurers and then some rendering or a brick or whatever fell off, you'd expect the insurer to say you should have told us.
    Precisely. And if the insurance broker I was talking to had said to me: "Oh no, don't worry about it, it's only cosmetic, it won't affect you" and proceeded to sell me the policy, I would hold him responsible if the insurance then told me I wasn't covered.

    The fosicon is there to help people - it's remit specifically includes looking at what is fair to the client / consumer given the circumstances. What the FOS doesn't do is look at what is fair to the advisor though. That is my point.
    I disagree. If the policy had been sold on the right terms, and the advisor had done his job properly, made sure that the policy he sold didn't have any structural cracks, so to speak, the FOS would not find in the client's favour.

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  14. #14
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    Default Re: Critical Illness - Legal and General

    "so to speak, the fosicon would not find in the client's favour."

    FOS doesn't work like that, and wasn't set up to work like that.

    Its specific remit is what is fair to the consumer in the circumstances. This is why so many endowment complaints were upheld even though a majority of IFA broker firms did everything right. They were still fined or made to give compensation.

    This is why you so many IFAs went bust - everyone thought that they could get some money when any advisor worth his salt did the right thing for the client.

    And this is why so many advisors now spend so much time doing pro bono work - to rebuild the reputation of the industry that was shattered by a rogue element of bad advisors.

    You really need to read up on the world of the IFADU (IFA Defence Union). For example, did you know an advisor has no right of appeal to a decision of the FOS even if they have got it wrong, and it has happened. I know of one case where an experienced investor who had an endowment got money. He was a very experienced and knew exactly the risks. It was a travesty.


  15. #15
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    Default Re: Critical Illness - Legal and General

    The OP specifically states that they had VIRAL labyrinthitis, not labyrinthitis caused by a brain tumour (the latter would constitute a critical illness, the former would not!). From what the OP has said, the cancer is not linked to the VIRAL infection in any way, and I can only go by what the OP has said - after all, they know more about their condition than you or I.

    I refer you to Bookworm's advice again:

    if you have medical evidence that you had viral labyrinthitis, I fail to see how they can use that as an escape clause
    ...and agree wholeheartedly. If they had viral lab. (too long to type again!) then it would be EXACTLY the same as the 'flu example I used earlier.

    Along the same lines, if the OP was told that viral illnesses did not need to be declared, and now they're using the viral illness to avoid paying out, then, I'm sorry, it can't be plainer that the OP was lied to when taking out the policy.

    Bill, you have my sympathy and I hope you make a full recovery.

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  16. #16
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    Default Re: Critical Illness - Legal and General

    Quote Originally Posted by Resoli View Post
    fosicon doesn't work like that, and wasn't set up to work like that.

    Its specific remit is what is fair to the consumer in the circumstances.
    about the Financial Ombudsman Service

    We are completely impartial - just as a judge would be if you took your complaint to court instead of coming to us.
    We are not a regulator ("watchdog") or a trade body or a consumer champion. Our role is just to settle disputes, as an alternative to the courts.
    Maybe you really need to read up on what the FOS does, rather than swallowing the union's party line. ;-)

    We are getting into a different discussion here, and I'd rather we didn't hijack OP's thread, so if you want to carry on about that subject, please start a new threadicon in the Bear Garden, since it is more a general discussion than an actual problem-solving thread. I'll be quite happy to move the relevant posts from this thread there once set-up.

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  17. #17
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    Default Re: Critical Illness - Legal and General

    BW couldn't agree more

    An insurance company was recently castigated in court when a judgement was held against them & they judge stated in summing up that it was disgraceful that they where trawling through application to find the slightest reason to void cover. This case was brought after the fosicon refused to uphold the claimant.

    As for the mis-sellingicon of endowments........don't get me started. If the buggers had done what they did with not only endowments but also pensions in for example the States they would be wearing orangeicon jump suits by now & taking their meals off tin trays with plastic spoons.

    The original poster needs to see a solicitor ASAP. In view of the illness any court action can be brought forward by application to the court


  18. #18
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    Default Re: Critical Illness - Legal and General

    I didn't want to get drawn into this one (this being my first day and all) but feel I need to add a few factors into this one.

    Firstly, let me declare that I am a financial adviser; ex IFA and now an independent mortgageicon broker.

    Please dont tar us all with the same brush, we are not all commission hungry fat cats with no scruples.

    FWIW, I've been in this industry for 15 years now and have helped numerous clients successfully receive their critical illness payouts from various life companies.

    Critical illness plans have been getting some real bad press this year; in particular The mail on Sunday finance section has featured a number of such cases where the life company refuses to pay out on the basis of "non disclosure". There are some valueable lessons for us all here:

    1. When applying for this type of cover, disclose ALL illnesses you have ever had.

    2. Always read the small print of the declaration you sign at the end of the application form, it specifically mentions failure to disclose previous illnesses (known as "non disclosure")

    3. If by reading this thread you are now in doubt about your own critical illness policy (assuming of course that you have one, as the majority of people dont) then review it ASAP. If you are unsure then either talk to your insurance broker or the life company direct

    4. There is pressure on life companies to underwrite these policies very quickly now (if mortgageicon related or the application is submitted via the internet for example) and therefore, in very many cases, the life companies no longer contact your GP at the point of sale. This therefore means that they only check your medical records if you make a claim and therefore if you have omitted a previous illness in your application, it will come to light when they check your medical records; so declare ALL previous ailments, no matter how small or immaterial you may feel they are.

    5. It is a good idea for everyone to review their policies every few years. In the case of critical illness policies, premiums have actually been decreasing as actuaries have more data now on aids. Also, some of the newer life companies coming into the market offer more comprehensive policies which cover far more critical illnesses than some of the earlier plans. One word of warning though, check to see if your monthly premium is guaranteed or reviewable. If you have a guaranteed premium now, make sure the new quote you receive is "like for like". In other words, make sure it is also a guaranteed premium also and not reviewable.

    6. For matters such as these it is always best to seek unbiased, independent advice.

    My heart genuinely goes out to the original poster on this one. I survived cancer myself, so I have a better idea than most of what you are going through and this L & G aggro is the last thing you need.

    Feel free to pm me and I will gladly assist you in any way I can


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    Default Re: Critical Illness - Legal and General

    Its after reading stories like these that I am ashamed at working for an insurance company (banks and insurance companies..its like working for the devil).

    While I can not offer any advice to you, all I can do is offer you all my best wishes and hopes for a recovery. Best of luck with it all!


  20. #20
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    Default Re: Critical Illness - Legal and General

    Quote Originally Posted by JonCris View Post
    The original poster needs to see a solicitor ASAP. In view of the illness any court action can be brought forward by application to the court
    I'm sorry but I have to disagree.

    The proper process to take on this one is:

    1. Complain in writing to L & G

    2. Ensure you ask in the letter if they contacted your GP at the point of sale for your medical records (this is known as a PMAR)

    It is unclear from your posting exactly how far down this road you are. If you get no joy from L & G then it is probably best to refer the matter to the Ombudsmanicon. If the Ombudsman feels that the selling agent should be made accountable for this, he may well refer it back to that company/individual. However, this raises some other issues:

    1. Term assurance has only been regulated by the FSA for a couple of years now, so, depending upon when you were sold the policy, the individual may not have been regulated by the FSA (you didn't say where you bought the policy from, bank, insurance company salesman, IFA, supermarket, etc)

    2. If it comes down to "your word against the adviser" then remember that you will have signed an application form giving the life company authority to contact your GP for access to your medical records and you also signed to confirm that you had told the truth about your medical history and had not omitted any relevent illnesses.

    Personally, I think you would be throwing good money after bad getting a solicitor involved until you had completely exhausted the above system, which is completely free of charge to you.

    Forgive my directness on this, but I do not know all the details of your medical condition. If your illness is terminal and your policy covers you for death or critical illness (most of these policies do), it is likely that there will be an option for L & G to advance you the Life Insuranceicon, before you die, on the proviso that your doctor confirms in writing that your condition is terminal.



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