Hi, I'd like to share the experiences I've had with L&G, Topquote (TQ), Openwork (OW) and the FOS.
In 2012 I had brain surgery (MVD) for a condition called Trigeminal Neuralgia (TN). After a few weeks recuperation I went back to work. This was, at the age of 40, my first illness (save the occasional cold) and got me to thinking about my wife and young daughter. I decided to arrange life and critical illness cover and called TQ.
The salesman must have mentioned a policy for my wife as well because I agreed. I told the salesman all about my TN and operation (when you've undergone a 7 hour operation involving a hole drilled in your head you can go on about it a bit too much!). The salesman told me that the policy was guaranteed and the premiums would not change for the duration of the policy (20 years).
Three days later a 'confirmation call' with the purpose of 'confirming I was happy with the policy and wanted to continue' (OW's words) was made. I was at work and busy and the call lasted just a few minutes. The TQ employee tells me that the reason for the call is for 'my protection'. He also says 'all I have down is one member of your family having cancer?' I reply, 'yes, that was my Father'.
He also asks if my wife will be happy, I reply 'she will, she doesn't know about it yet but she will'
The next day an Agent (or courier as Openwork insist on calling him) came to my house in the evening. My wife answered the door and thought it was a cold-call until he called her by name. She said 'you do know my husband's just had brain surgery?' and he replied 'yes'.
My wife was in the habit of photographing my the 4” 'S' shaped scar on the left side of my head which still had dried blood on it. She wanted to keep a record of my recovery plus I couldn't see it without a photo being taken. The hair on the scar side of my head was shaved for the op and although growing back it was noticeably shorter than the rest of my head and the area a few millimetres around the scar had no hair growth at all. This photo was taken less than 72 hours before the Agents visit.
We checked the applications and mine clearly mentioned my TN. The Agent told us the premiums were guaranteed and produced 'Statements of Price' confirming this which he duly signed and dated. Approximately a week later we received a 'Summary of Requirements' prepared by the Managing Director of TQ. In it he states that the premiums were guaranteed. They weren't. They were reviewable.
Everything ticked by as normal for a while and we just paid our premiums and generally forgot all about it. Things took a turn for the worse in 2015 when I fell ill. I spent a lot of time in hospital and was eventually told I'd had 3 silent heart attacks, Cardiomyopathy, and multiple Pulmonary Embolisms. I was diagnosed as NYHA 3.
After concentrating all our efforts into my health and when I started to feel a bit better we approached L&G and claimed on my critical illness cover.
Within a day or two of our claim being submitted L&G were on the phone. A softly spoken man who seemed so sympathetic towards my problems set about explaining that his advice to me would be to cancel my cover (I still wonder how many people take his advice and how he sleeps at night). I said that I wouldn't cancel so the calls continued. Each time yet another reason why L&G would not pay out was given. Once it was suggested that as the time of the heart attacks was unknown they may have occurred before I took out the policy (and presumably despite having 3 heart attacks I didn't go to the doctor, instead I organised insurance then waited 3 years to claim) This was before L&G had approached my consultant. When they eventually did he informed them that my heart attacks occurred no earlier than April 2015. L&G also said that as I was only NYHA 2 they would not pay.
After a while I was told (with a detectable hint of pleasure in his voice) that as I hadn't informed them of my TN my insurance was void.
I called L&G's MUTAL (Medical Underwriting Team Advice Line) to see if they had been contacted regarding my TN. They told me that although they keep records they don't keep the reference numbers needed to access them, these are given to the brokers and agents. Not the best system. I contacted TQ but, no great surprise, they claimed not to have contacted MUTAL.
At first, and probably understandably, I blamed L&G. They had treated me appallingly but I realised that they probably didn't know about the TN. So I turned my attention to the broker, TQ. I complained directly to them but, as can be predicted, got nowhere. They denied all wrong-doing and laid all the blame squarely at my door.
During the course of their investigation (I use the word loosely) their Complaints Specialist asked me to lend him all the paperwork that I had from L&G (600+ pages) I agreed, naively, yes but with his assurance that he would return every page to me. He didn't. He shredded them.
He did tell me that he had scanned and kept about 350 pages he felt of relevance to OW and he would print and return these. In the end about 150 turned up with an apology for his miscalculation.
One of the missing pages clearly stated that L&G believed blame lay with TQ and another said that L&G believed the problem occurred when TQ sent them my application.
I made a SAR for the phone call in which he promised to return my papers 3 times. They ignored my SAR claiming to have not received it. The ICO found them to have breached the DPA.
I moved on to the FOS where an Adjudicator took on my complaint. She received copies of the application forms from OW. Mine did not mention TN or an operation. The Agent's statement was taken as evidence by the FOS. Reading it you'd think it a description of an incredibly diligent, professional and experienced man of the utmost integrity. In his role he reports back to the office anything he sees that does not match up with the application.
Anything that is except bloody 4” scars and shaven heads.
I offered the photo of my head to the Adjudicator but she wasn't interested, I offered to pay for and undertake a lie detector test for me and my Wife and pay for the agent to have one to but that was also rejected.
I asked TQ for a copy of the original sales call. Unluckily for me but luckily for them it was 'lost'. Another convenient 'loss'. Even OW described losing the call as 'not good practice'.
I received an emailed copy of my application from the Adjudicator. The top centimetre or so was missing from the scans of each page. I thought this a bit odd and requested a copy directly from TQ. The copy they sent also left off the very top of the pages. So I asked again, this time specifying that I wanted the complete page. A copy arrived but scanned upside down! Their accompanying email offered an explanation for this. Their scanner didn't work unless the paper was placed on it upside down. I called Canon's UK service department to see if this was a problem they'd ever come across before. The engineer couldn't talk for laughing for several minutes before telling me that this scenario was simply impossible and a scanner does not differentiate between the right way up or upside down. The complete albeit upside down scans revealed a fax header.
The very next day my Wife requested a copy of hers. It arrived later that day. Complete with fax header and the right way up.
Over a long time hundreds of emails were exchanged between the Adjudicator and I. But to no avail. Using the confirmation call as her primary source she denied my claim. This call, despite being short enough to send as an attachment with no problems was edited by OW prior to being sent. A portion, I don't know how long, was removed from the start of the call.
The Adjudicator did make L&G apologise for their treatment of me and pay £300 in compensation. She also stated in writing that, other than a direct debit mandate, it was 'unlikely' that we had received any paperwork from L&G. Which we hadn't.
(the confirmation call is currently being looked into by the EU commissioner for justice as it does not appear to comply with EU Directive)
My complaint was passed to an Ombudsman who, despite the mountain of evidence and literally hundreds and hundreds of emails, made his decision in less than 5 days. Unsurprisingly he sided with TQ and OW.
My struggle continues though and I am far from giving up. In the meantime I have made a complaint with regard to my Wife's policy and the fact that it was not guaranteed as we had been told and was therefore mis-sold. Despite telling us a grand total of 7 times that our policies were guaranteed OW denied our claim. As did the FOS Investigator.
We told TQ's agent on the night of his visit that any increase in premiums would be unaffordable to us. The irony being that little did I know that the reason it would be unaffordable was the man who sat next to me and the company he represented.
I requested OW send me details of 'any and all' the commission from my Wife's policy. As is their way they denied having received my SAR. I sent it again this time recorded delivery and they had no choice but to reply. They offered a figure as the 'total' amount they had received. I called L&G who confirmed the figure from OW then went on to tell me about the monthly commission OW have been receiving and will receive for the next 15 years. I can only assume OW forgot all about it. I have complained to the ICO and expect another breach.
OW sent my wife a 'final outcome' letter in April of last year. A while later they sent another one, a sort of 'final, final outcome letter' if you will. Neither admitted mis-selling instead referring to it as an 'error' (or, more accurately, 7 errors).
The first final outcome letter from OW told us that we 'should've checked'. I can't help feeling this advice should be followed by the MD of TQ when he prepares his Summaries of Requirements. The paperwork that L&G received from TQ arrived with them sometime between the Agent's visit to us and the MD sending out his Summaries. The paperwork received by L&G stated that the policies were reviewable.
It's now in the hands of an Ombudsman who has (after 9 months) reached his provisional decision. He has found that they have in fact mis-sold my Wife's policy (in part). The 'in part' bit means he will not find that they did it intentionally as is my belief.
His solution is that OW pay my Wife £200 in compensation and that she be allowed to continue her insurance at the guaranteed monthly premium of £41.13. This is actually worse than OW's 'final, final offer' of £200 and future guaranteed premiums of £40.72. So since being found to have mis-sold the policy the penalty to OW has gone down and the cost to my Wife has gone up!
At this rate we will soon be paying them.
Please share your thoughts. Any advice is very much appreciated. Thanks for reading.