Marc Gander - The Consumer Survival Handbook


A 220 page introduction to all things consumer related by our own BankFodder.

Includes energy companies, mobile phone providers, retailers, banks, insurance companies,debt collection agencies, reclaim companies, secondhand car sellers, cowboy garages, cowboy builders and all the rest who put their own profits before you.

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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. #21
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    choudaryk Novitiate



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    Default Group Income Protection - Claim Declined

    Thanks no problem.

    I am working on my appeal, and the insurer hasn't contacted my GP during this period of absence. I will be asking him to write a letter in support of my illness.


  2. #22
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    Default Group Income Protection - Claim Declined

    Yes, but the dispute does not appear to be about whether you are ill or not. So the GP would need to know exactly what they are saying in order to be able to comment on it. If they are not disputing that you have depression again, but are saying that this has something to do with work, which it previously did not, then their support won't have any impact.


  3. #23
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    Default Group Income Protection - Claim Declined

    Quote Originally Posted by choudaryk View Post
    Thanks no problem.

    I am working on my appeal, and the insurer hasn't contacted my GP during this period of absence. I will be asking him to write a letter in support of my illness.

    Hello again.


    Has your employer told you what the policy wording says about appealing L&G's decision? This is what I have been advised that you need.


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  4. #24
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    choudaryk Novitiate



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    Default Group Income Protection - Claim Declined

    My employer hasn't provided me with any policy wording ref the appeal and the policy document doesn't mention anything.

    What the insurer has said is in the decision letter is:

    'If you disagree with this decision or you realise there is other medical information to assess, you can appeal the decision. We will consider any new or relevant medical information in support of the claim before issuing a final responseicon.'

    Hope thats what you meant.

    Thanks


  5. #25
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    Default Group Income Protection - Claim Declined

    That sounds helpful.



    If you are in touch with L&G, I still think it's useful to know what the formal appeal process is. They need to spell it out.


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  6. #26
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    Default Group Income Protection - Claim Declined

    After they decline you can appeal, they have 8 weeks to respond with a final decision and if not satisfied you ave the option of taking to the financial Ombudsmanicon.

    My main concern is that my employers will not allow me to take it to the FOS and instead terminate my employment if the insurers reject the appeal.

    These insurers and employers do have a very friendly relationship and can use this process to get the best result for them, which defeats the objective if you fall ill for a long period.


  7. #27
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    Default Re: Group Income Protection - Claim Declined

    Well, personally I'd be trying to find out as much as possible about how their appeals work, but it's up to you. I had my own problems with another insurer's income protection claim years ago and I think I won by understanding their appeals process.


    Do you have additional medical evidence to submit?


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  8. #28
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    choudaryk Novitiate



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    Default Re: Group Income Protection - Claim Declined

    Sangie595, Sorry I just noticed your response.

    The information they have provided states that they feel it is other factors not illness or injury that prevents me from doing the essential duties of my job, and that they do not consider me to be a incapacitated member.

    Thanks


  9. #29
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    choudaryk Novitiate



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    Default Re: Group Income Protection - Claim Declined

    Honeybee,

    Yes I am arranging additional medical evidence as we speak. In terms of their appeals process there isn't any other information from them or my employer.

    Thanks


  10. #30
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    Default Re: Group Income Protection - Claim Declined

    Quote Originally Posted by choudaryk View Post
    Sangie595, Sorry I just noticed your response.

    The information they have provided states that they feel it is other factors not illness or injury that prevents me from doing the essential duties of my job, and that they do not consider me to be a incapacitated member.

    Thanks

    Can you give us the exact wording of this please? Wording is all important.


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  11. #31
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    Default Re: Group Income Protection - Claim Declined

    Here you go:

    'we consider that it is other factors rather than illness or injury that is continues to prevent the performance of the essential duties of his occupation.'

    'we will immediately end payment of benefit if the insured member ceases to be disabled'

    Thanks


  12. #32
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    Default Re: Group Income Protection - Claim Declined

    Ah. And that is what we have been asking you for all along.
    So they aren't deferring it again - it's an outright refusal because they say you are not ill?

    I suspected as much, but was thrown by the references to linked periods and deferred payments. If they are claiming you are not ill, then you will need a lot more than a note from the GP!

    Do you have a specialist or mental health team referral? Anything else more than just the GP. Because, as I said previously, I am afraid that anxiety / stress are very easy to fake.

    I'm not having a go at you - but stress is the new "bad back". Impossible to prove or disprove, and GPs tend to be less than rigorous in their diagnosis. Having actually told people how to successfully fake stress, I know it's neither difficult nor complicated.

    I'm going to have to ask. I'm sure that you know what they are talking about. What, exactly, did you tell the rehab advisers? What did you tell them about work? Because that is a big problem.

    If you are perceived to have an issue with your employer, and/ or to be faking your illness, then there is no reasonable way in which you can exist any support from the employer in this matter.

    They won't tell the employer the full circumstances, but they'll tell them enough to at least give the employer a very good guess about what L&G know - and this is exactly the sort of thing that they aren't likely to back you up over.

    I understand. I know how it happens. You get talking and yippy don't stop to think what you are saying. But what did you say?


  13. #33
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    Default Re: Group Income Protection - Claim Declined

    Quote Originally Posted by choudaryk View Post

    'we consider that it is other factors rather than illness or injury that is continues to prevent the performance of the essential duties of his occupation.'



    Where I have seen similar wording used
    - personality clash
    - staying off when incompetent to do the job/ low performer - sometimes when the skills needed have changed over time, so no "blame" but just how things are
    - staying off to look after other people in the family who need a carer, and claiming it as illness when special leave has run out
    - series of illnesses due to being generally run down, but not amounting to a disaibility


    If any of these apply, we may be able to advise on the best way forward from your current position, wether you wish to stay or leave employment.


    But it is unlikely, without a lot of contradictory and time consuming medical testing, that you are going to get continued payment. I would think hard about wether you have the stomach for the fight, when there is slim chance of victory.

    Never assume anyone on the internet is who they say they are. Only rely on advice from insured professionals you have paid for!
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  14. #34
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    Default

    Ps. Please would you go back to my post 14? I asked you a lot of questions and you haven't answered any of them. If you need to, send Honeybee the answers and she'll send them to me.

    But, and I want to be clear on this in my usual entirely undiplomatic way... there is an issue between you and your employer.

    Your insurers have picked up on it.
    There is no point in telling us anything less than the full truth, because if you don't our advice will be wrong.

    There is nothing much that you could say that will shock me
    . There are loads of lousy employers out there.
    There are loads of lousy colleagues out there.
    There are even lousy employees.

    I'm a trade union official, but I don't think anyone has a corner on being right or sensible! I just know, and have thought this for quite some time now, that there is something else going on.

    I need to know what it is.
    The best advice isn't always, or even often, the advice you want.
    You are drip feeding information to get the advice you want.

    Believe me, it might not be the advice you need. P
    Please tell us what is going on.
    Via site adminicon if you can't post it here.

    Then I can figure out a sanitised version of the advice to put here for you. You are obviously in trouble, and we're trying to help.
    But that isn't always the help you think you need.

    Another Ps - I cross posted that last post with Emmzzi.
    But I agree with her totally.
    She gives great advice, and she's very experienced I'm told.
    Which always shows in her advice.

    You've now got two people telling you there's a problem.
    Let us help you fix it.
    Even if the fix isn't what you hope for.


  15. #35
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    Default

    Hi Sangie, thanks I do appreciate it,

    Honeybee has said that DX100UK has forwarded my PM onto you, let me know if you didn't get it was sent yesterday and if you need any further clarification.

    In short I gave an honest representation of the situation at work which they were aware of during my initial absence.

    I did discuss lack of support/adjustments for my symptoms when I returned to work and also the issues I PM'd you but at no point did I state anything that confirmed that these were the reason I was absent from work or they were preventing me from returning to work.

    my illness has progressively gotten worse over what is now a 20 month period. But the insurers have taken statements that I made from different calls to come up with their conclusion. (I have described all this in the PM sent to you)

    My GP is supportive and I have a consultant who is also will to provide a report that I am not fit to work and confirm that my illness is related to a previous illness. Please let me know if you have got the PM and message me back with any detailed points you want to know about and I will respond to you straight away.

    Again thanks for your advice I do appreciate it.

    Sorry I should have said none of the points that Emmzi kindly mentioned apply in my scenario, everything I related to them was around conversations with my employer around lack of support and how my illness affected me before I relapsed. Anything else I have stated I have sent to you in the PM which hopefully you have and if not Honeybee will now forward to you.


  16. #36
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    Default Re: Group Income Protection - Claim Declined

    My GP is supportive and I have a consultant who is also will to provide a report that I am not fit to work and confirm that my illness is related to a previous illness. Please let me know if you have got the PM and message me back with any detailed points you want to know about and I will respond to you straight away.

    In case it helps, could we confirm please whether both claims were for anxiety and depression or something else? What does the specialist do?


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  17. #37
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    Default

    Yes they were although I was diagnosed during my first absence but any health questionnaire by councillors and the insured showed anxiety and depression. The consultant is a cancer specialist and has seen my illness before.

    Sorry that should read I wasn’t diagnosed during my first period of absence


  18. #38
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    Default Re: Group Income Protection - Claim Declined

    So claim one was for cancer?

    And claim two is for anxiety and depression?

    Never assume anyone on the internet is who they say they are. Only rely on advice from insured professionals you have paid for!
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  19. #39
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    Default Re: Group Income Protection - Claim Declined

    No -

    Claim 1) was for stress related illness - then returned to work for a month and a half and relapsed (although I was scoring high for anxiety and depression but this information wasn't shared with me.)

    Claim 2) is a continuation of the original symptoms - and I was diagnosed with anxiety and depression a couple of months after I relapsed


  20. #40
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    Default Re: Group Income Protection - Claim Declined

    And the consultant is a cancer specialist because...?

    A psychologist would seem more appropriate.

    Never assume anyone on the internet is who they say they are. Only rely on advice from insured professionals you have paid for!
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