Critical illness claim

just wondered if anyone has had any experience claiming on a critical illness policy.
i was diagnosed in march this year i was told by my consultant i have parkinson’s and referred to the movement disorder team and assigned a parkinson’s disease nurse .i then received a copy of a letter that was sent to my gp saying probable idiopathic parkinson’s will this be a problem and hinder me making a successful claim. the policy states a definitive diagnosis of parkinson’s disease by a consultant neurologist. there must be permanent clinical impairment of motor function with associated tremor,rigidity of movement and postural instability .
My symptoms at present are rigidity bradykinesia tremor a bit clumsy when turning quickly and generally feeling slow when doing things .Any advice would be much appreciated .

Hi @leematt75,

Hope all is well.

I have passed your query onto our policy and department and will get back to you as soon as I can on this. In the meantime, please have a look at our website which has information on this here - https://www.parkinsons.org.uk/information-and-support/benefits-people-disability-and-carers

Take care for now.

Best wishes,
Reah

Hi leematt75.
Before starting claim procedure please read your policy document carefully.
I don’t have a good memory about critical illness claim. I was diagnosed pd 4 years ago when it’s early stages. I was declined the claim because I was not met with all of the policy definition. I was stupid to insurance claims at that time.
So please check your policy document carefully.
Good luck.
H

Hi @leematt75,

I’ve received feedback from our helpline department and they’ve advised that you take a look at the Financial Ombudsman Service. You can find the website here - www.financial-ombudsman.org.uk/publications/factsheets/income-protection-insurance.pdf

I hope you find this information useful.

Best wishes,
Reah

Did you eventually get paid out though or do your symptoms still not meet the requirements.

No. I could not get paid. My case is complicated
I was diagnosed with Parkinson Disease in 2014 and I had put my first claim for group critical illness to insurance company in early March 2015.
Insurance company sent me a reply in July 2015 stating that they could not pay a claim because my condition had not satisfied the definition of Parkinson Disease because my medical reports did not report me as having a tremor or postural instability. The letter also stated that I should remain a member of the scheme and should my condition deteriorate to the required severity after April 1st 2016, then they would be happy to reconsider a further claim.
But I had already deselected the group critical illness cover from my company benefits list on March 2015 as my claim was already made to insurance company and the policy document also stated that any pre-existing medical conditions or associated conditions are not covered. After receiving this letter, I did try my best to re-enroll into the scheme but the company could not open the window for selecting the group critical illness benefit until the following year, March 2016, and I immediately re-selected the scheme once available.

Inevitably, my condition deteriorated to the required severity, so I requested a second claim against group critical illness in August 2017. But insurer did not agree to pay the claim this time either stating I was not a member of the scheme between April 2015 and March 2016.

Hi Leematt75

I hope you are getting on well. I was just intrigued as to whether or not you were successful with your CRitical Illness insurance claim; I too have been told I definitely have PD by 3 neurologists, am on the meds etc but my clinic letter states ‘probable PD’ and also ‘previous symptoms and response to medication would support YOPD’ … my insurance too states ‘definite diagnosis’.

Thanks

I too am on here to share my experience and see if anyone has any golden nuggets of advice.
I have a Critical Illness policy that covers a diagnosis of Parkinson’s that requires me to also fail three Activities of Daily Living (ADLs) taking into account aids and adaptations.it was an addition to my policy I recently unearthed even though the insurer had previously written to me saying PD not covered - that’s another story though.
I’m OK on the diagnosis bit (had PD for over a decade), but I don’t fail the ADLs if I’m medicated. I’d fail the lot if I wasn’t!
Insurance declined my claim saying my medication is an aid. I took it to FSA who in their initial consideration told me they thought it “fair to say” medication was an aid. I’ve pushed back as I can find no basis for that. Everything I can see describes an aid differently, even the Equalities Act. I’m now very disillusioned and not hopeful.
I took this action following posts on this site from some years ago where others had been successful. Mine is a very old (30 plus years) policy that’s very modest in value and has no wording in the terms (or revisions) that mentions medication - unlike modern policies. I’m simply asking for fair consideration against their written terms and conditions as they sold it me.
Hey ho, guess if I keep paying in (it’s now very expensive for the return) I’ll deteriorate enough at some point for a future claim

Actually I can see I’ve missed out something crucial. In making my claim I’d asked to be assessed as unmedicated. This was because my very old policy didn’t say my assessment had to include medication as part of the consideration. It was at this point the Insurer said they would treat my medication as though it was an aid or adaption. Seems a new one on me. A walking stick yes, but my prescription - surely not!

Hi @Saddlers-2007,

I think you are on the right track with contacting financial ombudsman and I believe there is information on critical illness insurance on the Citizen Advice website - https://www.citizensadvice.org.uk/consumer/insurance/insurance/critical-illness-insurance/.

If you need more support on this, please feel free to contact our helpline on 0808 800 0303 or email us at [email protected].

Best wishes,
Reah

Hi Busymum3

Just wondering how you got on with your claim? I was diagnosed initially in September 2019 and have had DaTSCAN that supports diagnosis. Taking meds which are having some effect. My CIC insurer referred the case to their chief medical officer who are now stating they need ‘to assess the response to dopamine meds’ before considering my claim further. So now wondering if they will pay out

Hi sorry to hear you’re having problems. It would be worth speaking to someone qualified to look at your insurance policy and the exact wording of it.

As long as it wasn’t a pre existing condition when you took the policy out I can’t understand why they won’t pay you. Keep fighting

Karen x

Hi - I’ve just had my claim accepted by my insurer. It took two years and the help of the Ombudsman. My claim wasn’t based on the diagnosis of Parkinson’s, but the wording in my policy that required me to pass daily living tests with the help of aids and adaptations. My insurer said aids included medication. I contested this point as medication is not an aid and there was no reference to this in my policy. My policy is an old one - but if you have Parkinson’s and have not claimed on a critical illness policy or have been refused, I’d pore over the terms and conditions. Happy to share more information to anyone in the same position.

I am having difficulty as well in claiming against having Parkinsons diagnised before the age of 65.
The specialist has said “likely Idiopathic Parkinsons” but it has to be a definate diagnosis. I am worried because the policy ends in Oct 2022 and what happens if I do not get a definate diagnosis by then ? Does the insurance company still have to honour the claim ?

I have just had the same with my Group Critical Illness cover. Claim declined, Apparently I have something called a “Associated Condition” not full blown Parkinsons, even though the doctors letter I have a copy of states Parkinsons, but because they can get away with not paying on this Parkinsons “Associated Condition” clause they have declined the claim and flatly stated any future claim is “unlikely to be successful” effectively making my Critical illness cover totally worthless.

Does the insurer in questions name begin with “A” out of interest?