AXA PPP no longer covering active condition

[DonDan]

Hi All

 

First post here, happy new year to you all

 

I am writing on behalf of my wife who has been suffering from Graves disease (a thyroid condition) and thyroid eye disease for approx 18 months. She has needed regular (ranging from weekly to bi monthly depending on severity of the condition) consultations with her consultants throughout that period.

 

Recently we received a letter from AXA PPP stating that from the 5th Jan 2014 they would no longer be covering any claims made on these conditions as they now consider her illness to be chronic rather than active.

 

All of her consultants disagree with this assessment of her condition, she is definitely in the active phase and they have all written letters to AXA PPP confirming this.

 

However PPP are not interested in the doctor's opinion. They have stated to me that they consider a condition to be chronic if it has required a certain number of consultations or gone on for a certain length, regardless of the illness itself.

 

This just does not seem right to me and would appear to be a purely financial decision on their part that they have paid out too much already. My wife has had this insurance for many years and has paid them thousands of pounds in the process.

 

I will be appealing against their decision and would also consider going to the ombudsman to get them to reverse their refusal to cover her illness.

 

The doctor's (all highly regarded in their field) have stated that her active phase has gone on longer than the average, but that the average is just that, and as many people have a longer period of active phase as have a shorter one.

 

Does anybody here have any experience in this kind of appeal against an insurer? Is there anything particular i should be looking to do?

 

has anyone had any luck with a similar type of claim or are we fighting a pointless battle?

 

Any help would be most gratefully received.

 

Many thanks

 

Dan

[honeybee13]

Hello and welcome to CAG. I'm sorry to hear about your problems.

 

One way to argue this is to use the policy wording. Is there anything in there that mentions active and chronic conditions please?

 

I believe you can also speak to the ombudsman's office to see if they think you have a case, before you submit a complaint to them. As you probably know, you have to give Axa 8 weeks to try to resolve your complaint before you can escalate it to the ombudsman.

 

My best, HB

[DonDan]

Hi Honeybee

 

many thanks for your response, its a good idea to give the ombudsman a call.

 

There may be a way of arguing it using their wording as they talk about covering the initial period so the doctor's can sort out a regime of medication. As my wife's condition seems to be a particularly awkward one (the condition, not my wife, well maybe...) the medication is constantly changing so that may be an avenue to try.

 

Many thanks

 

Dan