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Injury Insurance not paying out


curly bob
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Has anyone any experience with Injury insurance please? I took out a policy in around 2005 to cover me in the case of an injury and I was unable to work as being self employed it seemed a good idea I found the company B&CE in a trade magazine and they were then advertising as a company that would pay out even for common injuries like a bad back I called the number and cover was arranged since that day I have never had any documentation from them ( I should have chased this bad I know:!:) The premiums were paid direct debit every month and I occasionally rang them to check I was still covered and that they were still trading !!! After a recent injury resulting in an operation I asked for a claim form etc and duly made a claim please see their reply letter attached my questions are how is someone with no medical experience be expected to be able to make a decision of the cover offered and if Ligament damage is better cover than Tendon cover, also with no documentation for over 8 yrs how was I supposed to know what I was covered for.

 

Thanks

CB

Still Fighting 4 PPI claims getting there slowly :smile:

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Hello there.

 

I hope the forum guys will be along with advice for you later. I think it might be worth asking for a copy of the policy document that you should have had.

 

The pdf letter does say that if you have a medical letter that says it's ligament damage they will reconsider. Is this a possibility?

 

It might be worth ringing the ombudsman's helpline. I believe they will tell you if you might have a case against the insurer or not.

 

My best, HB

Illegitimi non carborundum

 

 

 

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See your Doctor with the letter and see what they say. They will just have looked at the Doctors letter, taken advice about the medical issue and then interpreted this in line with the policy. I am not an expert in human biology and don't have sight of the policy wording, so difficult to comment.

 

These companies that deal with the claims will have medical people they refer Doctors notes to and they will have been told this information. It is not unknown for mistakes to be made. You need to speak to your Doctor to clarify and also you need to examine what the policy wording states.

We could do with some help from you.

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Thanks for that I have emailed a copy to the Dr and await his reply , unfortunatly I have never seen any documentation regarding this cover may be I should contact them and ask them to send me a copy ?

 

Thanks

CB

Still Fighting 4 PPI claims getting there slowly :smile:

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Thanks for that I have emailed a copy to the Dr and await his reply , unfortunatly I have never seen any documentation regarding this cover may be I should contact them and ask them to send me a copy ?

 

Thanks

CB

 

Yes you need a copy of the policy you signed up to. Make sure you ask for a copy of the policy from 2005 and not the latest policy wording, as the wording may have changed.

We could do with some help from you.

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Just thinking not that I dont trust Insurance companies :-) would a SAR be a better idea ? just to see the exact start date etc and what information they have??

Thanks

CB

Still Fighting 4 PPI claims getting there slowly :smile:

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Just thinking not that I dont trust Insurance companies :-) would a SAR be a better idea ? just to see the exact start date etc and what information they have??

Thanks

CB

 

That is up to you. An SAR can take up to 40 days, so you could just write to their compliance asking for a copy of the original policy documents, as these have never been received.

We could do with some help from you.

PLEASE HELP US TO KEEP THIS SITE RUNNING EVERY POUND DONATED WILL HELP US TO KEEP HELPING OTHERS

 

 Have we helped you ...?         Please Donate button to the Consumer Action Group

 

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Thanks for that I will do that today , the consultants reply is below i will send this off as well but dont hold out much hope

"thanks you for your query. I can confirm that your shoulder injury is related to tendon tear(rotator cuff tendons).

the insurance policy mentioned ligaments, strictly speaking tendons are different both functionally and structurally.

 

however in the shoulder especially they work very close together. In general purely ligament damage is more sports related while rotator cuff tendons tear are accident related.

 

If you had taken this insurance policy hoping to be covered for shoulder injury(which should ideally be both ligament and tendon), I understand your disappointment.

 

I am sure the insurance company will understand this and will consider your request favourably. this may be have been an oversight on their part and in fact I would recommend that the form be amended to include tendons as this will clarify things both for the company and the policy holders "

 

CB

Still Fighting 4 PPI claims getting there slowly :smile:

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