Group Insurance Policy payments suspended - * RESOLVED AND PAYMENTS RESUMED *

[fattys_leg]

Hey good folks

 

I'll try to make this to the point, at this stage I could probably write a PHD on how collusion within the layers of GIP's are designed to make everything opaque.

My claim for income protection through my employers GIP was initially accepted, but subsequently stopped after an "independent evaluation" - if you know, you know.

I submitted a very strong appeal, addressing every point raised in the decision letter, backed up with supporting letter with no ambiguity from my treating specialist. 

I was advised the appeal process would take 45-60 days, its now been three weeks since their advised timescale has passed (it took a week of that for them to acknowledge the appeal) I've contacted my employer for an update, however they are not receiving a reply from the broker.. 

 

Am I right to expect the decision letter to be dated within their 45-60 day timescale? (when received)

Is a total 3 week delay, skirting the edges of the duty of care the broker is adhered to?

 

Thank you for reading!

 

 

[mantis shrimp]

I suggest that you point out the time taken and ask for a detailed response as quickly as possible.

 

As you have not explained the role of the broker, it is not possible to say whether the broker owes you any duty of care.  It seems more likely that any claim you have will be against the insurer.

[honeybee13]

It's possible that your employer is the client of the broker which makes your life more difficult.

 

Are you dealing with this through your HR department? Who is the insurer?

 

HB

[honeybee13]

Have you received a copy of the insurer's dispute procedure?

 

HB

[fattys_leg]

Thanks Honeybee, Mantis. I emailed my employer the date the 60 days were up, they claim to have only had one response from the Broker (Aon) since confirming delayed acknowledgement from L &G. I've emailed my employer a few times since, and have been told they will be in touch when they have a response.. each time. Layers and Layers which may only be penetrable with a SAR against insurer and broker? (I had to raise one with my employer to get a copy of the policy. I've read that the duty of care applies to everyone in the chain, except seemingly me! 

 

[fattys_leg]

8 hours ago, honeybee13 said:

It's possible that your employer is the client of the broker which makes your life more difficult.

 

Are you dealing with this through your HR department? Who is the insurer?

 

HB

Seems my employer is the client of the broker, everything is still going through HR at this stage, It's really no bother to wait, I just want this finalised so I can concentrate on my health, i'm able to wait as long as needed and have factored in the time it may take for the Ombudsman to pass judgement. I could just do without the wrangle, but it seems this is what they thrive upon.

[honeybee13]

Hi.

 

I've spoken to someone who has dealt with this kind of policy in the past. If you're dealing with Aon and L&G, it sounds as if your employer is a reasonable size company so hopefully they have the resources to deal with this.

 

The person I asked suggests you write to HR pointing out that this is about income replacement in your situtation and that obviously it's important for you and making your life difficult at the moment.

 

Say that it's now beyond the time frame that you were given for a response and say you would like to escalate it into a formal complaint. Ask if it needs to be a complaint against your employer or against the insurer and what the procedure is.

 

My contact thinks if you tackle it this way, if it does end up with the ombudsman you'll have followed due process, which is seen as important.

 

I hope that helps.

 

HB

 

 

[fattys_leg]

A quick update, found this on the FCA website/handbook. There's no reason for the delay, and 3 weeks past their own timesclae, no contact  (ICOBS 8.3 Insurance intermediaries (and insurers handling claims on another insurer’s policy)

 

Dealing with claims notifications without claims handling authority

ICOBS 8.3.4G06/01/2008RP

A firm that does not have authority to deal with a claim should forward any claim notification to the insurance undertaking promptly, or inform the policyholder immediately that it cannot deal with the notification.

[honeybee13]

That could be a useful find, FL. Are you thinking of Aon?

 

HB

[fattys_leg]

9 minutes ago, honeybee13 said:

That could be a useful find, FL. Are you thinking of Aon?

 

HB

Hey HB, yeah A on.. i'll be keeping a close eye on the dates of all docs/emails! Whenever it is they decide to reply i'll follow up with SAR and complaint to FCA

 

[honeybee13]

Be careful with the timing. You're supposed to go through Aon's complaint procedure, give them time to resolve your problem and after the requisite time - 8 weeks? - you can take it further.

 

This is why I mentioned having or getting hold of a copy of their dispute resolution procedure. Do you think Aon are the problem rather than L&G?

 

HB

[fattys_leg]

Thanks, I was just reading about the complaints procedure, i'll need to request it through my employer. Its hard to say where the delay is until I receive the decision letter and see how the dates align.. and why there has been no decision or communication. Oh well, springs coming

 

[honeybee13]

Their communication sounds not very good, unless things are stuck with your HR. Have you seen Aon's service standards? Or L&G's, come to that.

 

HB

[fattys_leg]

Hey, a positive up date to this thread. My employer emailed today and my appeal has been accepted. Its been very drawn out. PHI through employers GIP is very confusing, a critical mind may think its by design. I'm happy to offer advice to anyone caught in this vacuum 

[honeybee13]

So L&G are going to start paying you again?

 

HB

[fattys_leg]

1 hour ago, honeybee13 said:

So L&G are going to start paying you again?

 

HB

 

Hey HB, Yeah back payment and continuation, I wrote a strong appeal and supplied supporting medical evidence. Anyone who has had an independent assessment will understand how horrible and personal it is.. feels like vindication 

 

[honeybee13]

I know, it's a huge relief to be believed. That's excellent news for you, I'll amend your thread title to show the result.

 

HB

[mantis shrimp]

Great news