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Legal & General - Critical Illness claim issue


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Hello all

 

First post as I came accross this site when googling about challenging critical illness claim decisions.If I can post up my scenario I would be grateful for any comments from mods/members.

 

I have had clitical illness cover (as part of a flexible pay scheme through my employer) for myself and my wife.The cover had been in place for a couple of years (2 units for me and 1 for my wife) with L&G.

 

In June 05 my wife went to visit her GP as she had a lump in her neck.He referred her to an ENT specialist who said that there was nothing to worry about as it was a swollen Lymph node that didn't represent any problem.

 

In September 06 I had to review my flexible salary package and chose to increase our level of CI insurance by 1 unit each (the maximum increase allowed per year).

 

In May 07 another lump appeared in my wifes neck and again, she went to see her GP, was referred to the same ENT consultant and after a variety of tests my wife was diagnosed with follicular non-hodgkins lymphoma in June 07.

 

We submitted a CI claim to L&G in June and have just heared today that they will only pay out on the original level of cover (1 unit) and not the level of cover at the time of diagnosis.At the moment we understand that they are implying that we upped the level of cover after the first consultant appointment (when he said nothing to worry about) and so do not get the increased level of cover.We know that her Lymphoma consultant wrote to L&G and explained that there was no way we could have known about the illness at any stage prior to the diagnosis but, after lengthy consideration, L&G have informed us that they will pay out only on 1 unit of cover.

 

Can anyone advise if there is best way to contest the claim and whether it is worth taking legal action to try to obtain the payout for the second level of cover?I am waiting for L&G's letter to come through at the moment.

 

Thanks in advance

Dean:)

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Don't faff about, that's one for the Ombudsman and no doubt about it. The insurance Ombudsman actually do crack the whip, and with the consultant's evidence, I would think the odds are pretty good in your favour. Yes, there may be an argument that you chose to up the limit "just in case", but hey, that's what we all do when we take insurance in the first place, is it not?

 

You need to make sure that L&G give you a "final decision" on the matter (eg that you have exhausted their internal complaint/review procedure) then Ombudsman.

 

Please please let us know the outcome, as you saw for yourself, the power of the Internet relies on people updating their stories for others. :-)

 

Best wishes for you and for your wife's recovery. :-)

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Another related point is that in 2006 we moved house and took out a Life Insurance policy with standard life to pay off the mortgage in the event of one of our deaths during the life of the mortgage.We disclosed the first GP's visit and the visit to the ENC specialist on the application form and Standard life wrote to the ENC consultant asking for his opinion in the context of our application.Presumably his reply was to thier satisfaction as we were subsequently offered a policy which we accepted and is currently running.

 

My concern now is that if my wife dies, will Standard Life settle our mortgage or will they say that even though the date of diagnosis was after the policy was started we are not covered as the initial consultant visit (in June 2005 when we were told nothing to worry about) was before the policy started.....in much the same way Legal & General are saying they won't pay out on the increased level of cover?Should I contact Standard Life with this query so I know where I stand or is there the possibility that they will cancel the policy as they know there is a strong chance they need to pay out?Do I need to advise Standard Life of the diagnosis?

 

Thanks.

Dean

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I think maybe take each day as it comes...

Deal with the existing problems first...

They can't cancel the policy this way, no. They wrote to the consultant, charged you a premium according to what the consultant's answer was, they can't turn round a few months later and say "hang on, we've changed our minds now, policy is null and void".

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