Please Help: Scottish Provident Illness Claim after Head injury

[mimipa]

Hi all... I would really appreciate any feedback or advice you guys could possibly give on the position I am in... especially if you have dealt with Scot Prov on a claim(or can point me in the direction of others who have)

 

background:

a few years ago, my partner was involved in quite a serious RTA. In the time following his accident he has been unable to work (he was a very high-end computing professional) and is pretty much housebound. He has all the typical symptoms of a moderate brain injury, and has limited mobility - ie can shuffle a few yards. His problems haven't changed (in fact have gotten worse) over the past few yrs. Despite this nothing 'concrete' has been found on all the numerous tests, scans etc run on him and the docs still cannot determine what is wrong. Privately they have all told me it is unlikely that he will get back to who he was pre-acc.

 

There is a Personal injury case still going on and other income protection policies he had (none of which have made any progress to date) but I would like to ask advice for just one of them (as it is just too much to cover here) - a critical illness and permenant disability policy with ScotProv. This is potentially a high payout for them over £100k of cover - so I appreciate it will be very big task.

 

Scottish Provident:

 

We filed a claim with them over a year ago as we were unsure as to the extent of his symptoms and how long they would last - and whether they would apply for a 'permenant disability'. According to the small print this seems to mean he will be unable to perform the role he did before - as I said, his drs have told me this is highly unlikely.

To date, they have requested and received all his medical/hospital notes and no decision has yet been made. they are now passing it on to an 'independent medical team'. I imagine this means an independent medical exam and so on. I am worried what this really means as in the past (with other policies) I have found that an 'independent' exam is just a way of seeing how they can label the claimant fraudulent.

 

I am feeling really disillusioned with the whole debacle - I thought the point of cover was to protect you if you were unable to look after yourself due to illness/disabilty etc. Instead it seems that we are caught in a game with insurers trying to find a way to wriggle out of paying!

 

I'd like to hear from anyone who has gone through claims with them, and what you have experienced. I really want to know what I need to do to bring this matter to a close - asap.

 

thanks!

[Endymion]

Can you clarify that you partner was the innocent party and is making a claim against the TP for damages?

 

If so, is there an admission of liability, have proceedings been issued and has there been any interim payments?

 

I ask this as you have made a claim on your ciritical illness insurance, however, you cannot 'double up' as it were on your PI claim. By this I mean you cannot claim for a loss of earnings/care & assistance etc if you have already received a payment that may cover your losses from your own insurance company. It may then fall to your insurance company to make a claim from the TP in the accident to recover their outlay etc, but more importantly, it may, albeit doubtful, compromise a settlement with the PI claim and any recovery they may want to achieve may be prejudiced by any settlement you make and vice versa.

 

Of course you have to mitigate your losses and so may have to make a claim on your insurance, but you really need to discuss this with your solicitor as to what effect this will have on your special damages claim as you may only have a duty to claim against the TP and not utilise your insurance.

 

Quite a complicated situation and with the monies involved you really need to have a long discussion with your solicitor and barrister in a conference regarding your past and future special damages claim (especially if the prognosis is unclear as to how he will recover/job prospects etc).

[mimipa]

yes, he was innocent in the RTA. The other party was an uninsured driver and was charged after the accident with dangerous driving.

 

The case of the PI claim is still ongoing and very complicated - due to the lack of concrete medical evidence about his injuries. Liability still has not been settled, despite the charges against the driver and witness' statements about his driving behaviour. They haven't disputed it though so the solicitor wants to press this issue after issuing proceedings to them.

 

Re SP: the claim is for TPI and they have not said anything about a possible overlap with any other policies he has - I know with his Payment protection policies etc they are factoring in the PI case and that will affect any decision they make. If they have not raised the issue do I need to pick it up with them? So far they only seem to querying the medical issues and have not asked anything about other policies elsewhere.

[Endymion]

I would discuss any insurance claims you are making with your solicitors. They will know a hell of a lot more than anyone on here knows as they have all the facts of the case and can look at the policies if needs be and they will be able to give you advice and ease your mind.

 

It may also be the case that the insurance policies won't pay out as the TP will be liable for any losses incurred.

 

if that's the case, tell your solicitors you need them to issue proceedings asap to have a trial on liability as a preliminary issue.

 

Turning to the SP - it's always natural for the insurers to have the medical records etc examined by their experts, however, as they have (if they pay out) a chance of recovering their outlay from the TP, then it is likely that they will be less inclined to, how shall we say, be less bullish in the amount they pay out to you and the parameters for meeting the criteria necessary for payment may well be not as high.......of course that is simply speculation:wink:

[honeybee13]

Hello, sorry to hear of your problem. It could be worth having a chat with the Financial Ombudsman Service's helpline to see if they can throw any light on what should be happening. If you can't reach an agreement with Scot Prov, that could be who you end up complaining.

 

HB