Serious Illness Cover - Payout?

[lucify]

Hello Everyone

 

I hope you can help me. My husband has been poorly for over 9 months now and he has been diagnosed recently as suffering from Pancytopenia caused possibly by Peripheral Consumption/Destruction, exact cause still unknown.

 

We have claimed on our Serious Illness cover, but the wording in the policy is ambiguous. It described his condition as Advanced Aplastic Anaamia and the exact wording is as follows;

 

Aplastic anaemia is the reduction of circulating red

cells, white cells and platelets. For the purposes of

this plan pancytopenia, causing a reduction to 10%

of the normal number of white cells and platelets

as well as 50% of the normal levels of red cells,

must be present. All lines of blood production must

be depressed as demonstrated by bone marrow

examination and abnormalities persisting on blood

tests for a minimum of three months.

 

My husband fits all the definition and criteria as described in the above statement, however the consultant is unable to confirm Advanced Aplastic Anaemia at this stage because it could be something else, like a very rare form of cancer or bone marrow disease.

 

I am concentrating on the fact that the wording states that 'for the purposes of this plan, pancytopenia' - well that is exactly his diagnosis so therefore does that mean the plan should payout?

 

I have sent my eyes square reading and re reading the policy wording, but could just do with some outside opinions.

 

Do you think we have a chance of a payout?

 

Many thanks in advance

L xx

[unclebulgaria67]

Think it is saying that they will need more information to evaluate whether the condition triggers a payout. Blood tests over a 3 month period and bone marrow examination. It has to meet the definition of the serious illness they have stated. This is probably not stated in the policy, but is their own Doctors definition of serious illness and of course you may have Doctors that have a different opinion, which would lead to you needing to raise a complaint.

 

This is not something I have dealt with, but this is my reading of it. From what I have read, arguments about what is a serious illness, are pretty common.

[lucify]

Thank you - we have sent evidence of blood tests over the last 6 months plus - detailing depressed white blood count, platelets and red blood cells - he has almost 95% reduction in white blood count and platelets and red blood count is reduced by over 70%. Has been the case for 6 months, he is getting worse not better. Now requiring fortnightly platelet and blood transfusions.

 

His letters all state Pancytopenia so I hoped this would be enough to fit the category. I am really at a loss as to what they will say, I know that most insurers try to get out of paying if they can. but it is just hard to swallow, especially when you or your partner could lose their life because of the illness.

 

Thank you again for your help.

[unclebulgaria67]

Thank you - we have sent evidence of blood tests over the last 6 months plus - detailing depressed white blood count, platelets and red blood cells - he has almost 95% reduction in white blood count and platelets and red blood count is reduced by over 70%. Has been the case for 6 months, he is getting worse not better. Now requiring fortnightly platelet and blood transfusions.

 

His letters all state Pancytopenia so I hoped this would be enough to fit the category. I am really at a loss as to what they will say, I know that most insurers try to get out of paying if they can. but it is just hard to swallow, especially when you or your partner could lose their life because of the illness.

 

Thank you again for your help.

 

Think you need your own Doctors to respond to the Insurers with the information and that the condition does fit the insurers definition of serious illness.

 

I suspect that the Insurers staff receiving the information are not medically qualified and may not understand the situation unless it is made very clear to them. They may have Doctors they refer to, but if this is by telephone calls giving bits of information, they may no have had all of the information correctly given to them.

[lucify]

Think you need your own Doctors to respond to the Insurers with the information and that the condition does fit the insurers definition of serious illness.

 

I suspect that the Insurers staff receiving the information are not medically qualified and may not understand the situation unless it is made very clear to them. They may have Doctors they refer to, but if this is by telephone calls giving bits of information, they may no have had all of the information correctly given to them.

 

Thank you I will try this.

[lucify]

Quick update everyone, after a lot of arguing and promises to involve the FoS, hey have paid out 50% now and the remaining 50% in 3 months time.

 

I did have to escalate to the top, literally speak with the Chief Operation Office and CEO himself, but we got there

 

Thanks everyone xxx

[mascotty02]

Hi,

I have recently been diagnosed with cancer, I have had operations and chemotherapy, and thankfully I am now recovering, I took a month off work in total, due to having to continue to pay my monthly bills, is there somewhere where I can claim, I only got basic SSP and didn't claim anything for the time I had off, but am in a lot of debt now and trying to play catch up, is there a a government place where I can claim to get myself back out of debt, I have been working all my life and contributed to everything and to get knocked by this dreaded disease and trying to get my life back on track, any help and support would be appreciated and thanks for any advice in advance