Critical Illness Claims


#1
Hi there, I haven't done this before so please forgive me if I get the admin bit wrong. I wanted to share a few points with anyone who has had a struggle to be paid out with critical illness polices or others for that matter for PD because 'you are not bad enough yet'. Check your documents closely to see whether you have all the original docs ie. the Policy Schedule, the Terms and Conditions, the Know your Facts document and also any brochures. Read through each document carefully and check whether it states that the tests they assess you against actually state you have to be assessed when medicated. The Disability Discrimination Act states that where there is a disability and tests are applied, if medication taken alleviates the symptoms but does not cure them, then the affect of the medication should be ignored. (This is my interpretation of the DDA paragraph). Policies generally state that they comply with English or UK legislation and so in my mind, they should be guided by the DDA's legal guidance.
I was paid out on this basis after some persistent communication. Nowhere in my documentation did it say I had to be assessed when I was medicated and I am clearly worse when not medicated. I hope this information may help someone.
Best of Luck

#2
my 1st mortgage had critical illness and it paid out when i was diagnosed

#3
Hi Bodget, thanks for your reply. I'm really pleased that your policy was paid out on diagnosis. That is how I thought my policy would work too. For many people though, from what I understand its not like that and they are declined because they pass the tests when they are medicated. Good to know some are paid without any grief though

Tinker

#4
Good morning Tinker,

That information is very useful, it is too late for us but if you don't mind it would be very useful if it was printed in the Parkinson mag or perhaps the information department could do a fact sheet on the subject as it is such a worry for most working pwp's and their families. It would also apply to some other conditions, if you have a document on the subject I would be very grateful if you could send it on email to me.
You have won a great victory and it will give hope to many peole.
kind regards
vivian

#5
Hi Vivian,

Thank you for your reply. I am happy to email you the points I challenged and any information that would be useful. It might be a couple of days if that is okay?
Am I right to assume you are you part of the Parkinsons UK team?

#6
I have posted on this topic before.Many policies are sold without Parkinson's as a specific condition. They tell you it is covered by PTD. Permanent and total disability. That means you have to wait until you cannot carry out three of the six activities for daily living. Wash, feed yourself,dress,ambulation,bowel and bladder management and transfer.
I advocated and do so again, if you have offspring age 18 or over take them to an IFA. Tell him you want a policy that covers the greatest number of illnesses.Ask him to provide you with the list and ask for the Company definitions of the illnesses.get a policy for a specific term the longer the better.A 40 year policy is peanuts for an 18 year old but premiums are higher the older you get.Do not see the premiums as dead money, I only paid mine for two years before it paid out.
Arrange your policy through the IFA you asked the details from because 1) he deserves his payment, 2) you will have greater protection under the Financial Services Act.

One other thing that always bothered me is the fact that many of these policies were sold alongside mortgages. When it came time to move or re mortgage the original policies get kicked into touch by the new mortgage arranger and were replaced with new policies. Sometimes it did save people a couple of quid but often and what was not taken into account was that the illnesses definitions were substantially different. For instance in old policies both Testicular and Breast cancer were covered in situ. Many new policies only covered these conditions if they had travelled so they did not payout until much later. That is the reason I say buy your policy for the largest amount and for the longest term and you will then not need another policy for your mortgage.Be warned that the Mortgage arranger will do his damnedest to sell you one though.

#7
Message for Vivian.

Hi there, I hope you don't mind Vivian, I just wasn't sure if you were saying that you personally would like some info or if it was on behalf of Parkinson's UK? Could you let me know?
Many thanks
Tinker

#8
I'm about to try and claim on my insurance though it will have to be the disability route. I have looked on my paperwork and I can not see anyhing about medication. If anyone has any advice on claiming it would be much appreciated. It seems scary...

Thank you

#9
Hi everybody, I agree with Viv that this information would be really beneficial to newly dx people. I was dx 12 years ago and didn't know until about 3 years ago that I could have claimed on my critical illness policy in respect of my mortgage. It's too late now because since then I have changed my insurance company a number of times and as a result I am still paying my mortgage but can't work due to my condition. I did actually find out on this form, however I do think that there should be some financial advice offered to people at the point of dx because there must be others like me that have lost the opportunity.

glenchass

#10
Hello Snowflake, I havent been on for a while so you may have already completed your form, however if by chance you haven't, I would encourage you to challenge the insurance company IF you are sure there is no mention of being medicated whilst being 'assessed' against the test criteria. Read through the policy and any brochures you were given at the time you took it out. If there is nothing about this, then you need to consider whether you would 'pass' the tests (i.e. you would be eligible to claim) if you were assessed when unmedicated. You have to base your answers on how you would be if you didn't take medication, and state on each answer that this is when unmedicated. They will undoubtedly come back and state that they only assess when medicated. That is when you would need to contact them and challenge where in your documents is that actually stated. I'll leave it there at the moment but even if you have already sent the form back, you may be able to complete another. Hope it helps
Tinker

#11
hi i had my morgage with halifax,when i was dx 11 years ago,i was speakin to a financial adviser who i no personally in tsb whom i also bank with for many years,we was chattin about pd etc,he said to me have u got critical insurance,and i said yes ,why ,he said bring ur paper work in to him and he will go through it,that he was pretty sure parkinsons was one of the diseases that ur morgage could be paid off in full.well wot a shock,i did exactly that,and he was correct,he even made phone calls on my behalf,when i had givern my consent cus it all confussed me.and with in 2 months the cheque came to me,i could either keep the money or pay my morgage off,i chose to pay it off,it covered the rest which was left on it,66 thousand pounds,i thought it best cus i had left my job ,and with out a morgage it made lefe alot easier.PLEASE CHECK YOUR PAPERS THOUGHLY:smile:

#12
Ali makes a very good point - something very similar happened to me. In my case there was a clause in the insurance requiring that you inform the insurer within 6 months of diagnosis.

It can be hard to pinpoint the date of diagnosis for Parkinson's and most people have quite a lot to think about at that time but CHECK YOUR PAPERWORK NOW!!

In fact in my case I didn't find out that I had critical illness cover until quite a bit after the 6 months 'deadline'. The insurance company were very understanding and despite this they paid out.

Elegant Fowl

#13
Morning, I agree with Ali and Elegantfowl. You must check whether or not your policy covers PD. In my case they said it did, but only in the Loss of Independent Living section - and then they said I wasn't eligible to claim under that part of the policy because I wasn't bad enough. But without medication I knew I was bad enough - I would not be able to do many of those things they test you for unmedicated. On this basis, I would never be eligible before the policy expired. My policy didnt state I needed to be medicated when assessed and on principle I challenged that. So do check if your policy covers you but if you have a similar experience to me, check the detail. You may still be eligible to claim.