Critical illness cover problems!!

kcmoore

We have our mortgage with Bank of Ireland and have bn paying 67 euro a month critical illness cover. I had open heart surgery a few weeks ago for valve replacement and aneurysm repair. When I was diagnosed with this problem I rang BOI life and we went to our local branch and told them but we were given a brochure to read through the list of conditions covered (both of mine were) we were told no problem come back when the time comes to have surgery and not to leave claim to long after surgery. Well we have just put in our claim but are worried as I had a read through some small print which said about claiming half life cover on diagnosis and the rest paid down after surgery along with some other small print never explained when we spoke to this guy! I also feel we should have had to fill in some paperwork before now and on the day we notified them in our local branch. Cant help but feel we've bn taken for fools and money we've paid out over the years is gone down the drain. Has anyone heard of problems like this or how does it work!!

phormium

I doubt that is going to be any issue, bear in mind people don't always have advance warning of a diagnosis so can't possible submit the claim in advance of a surgery. For example if someone gets a sudden heart attack and needs a bypass or similar, this could be done before they even leave hospital from the heart attack so last thought is going to be heading off to fill in claim forms.

That option is more than likely just an added benefit for someone who does have a diagnosis pending surgery and where the money could be useful to pay bills etc where there maybe a period of unemployment or similar between diagnosis and surgery/recovery.

skippy2

Always think Income Protection is a better policy to have as opposed to Critical Illness Cover, too many ways for them to weasel out of the Critical Illness

Henry Ford III

skippy2 wrote: »

Always think Income Protection is a better policy to have as opposed to Critical Illness Cover, too many ways for them to weasel out of the Critical Illness

They are very different certainly. Best choice depends on the circumstances.

phormium

Totally different products though with very different benefits.

alig123aileen

Firstly, I am sorry to hear of your illness and wish you a speedy recovery. I have some background in this and am happy to help if you want me to and I don't charge for this.

The full list of illnesses covered are most likely not on the brochure you were given because this is is most likely the sales brochure of illnesses covered now. You should consult the policy document terms and conditions you got at the time you took out the policy. If you have not got them ask in writing for a true copy of the terms and conditions attaching to the policy in the month and year XXX when you took it out. life companies constantly reduce the illnesses covered under the Serious illness policy if their claims experience is above average. However unless notified otherwise (and you consented to the removal of same) you should still be covered for the illnesses you were covered for at outset.

When you get your terms and conditions its often good to get your private medical consultant to fill in the part as it lends more weight than a doctor. The insurance company may argue over whether it qualifies under their description and this is where you consultants expertise could be the difference between paying the claim and not paying the claim. And tell the insurance company in writing you will go to the Insurance Ombudsman if you cannot claim under the policy. When they see this they must give you their final position. Also if your branch told you something different regarding the claims process and this has affected your claim you need to raise this as a grievance and say you want to go to Ombudsman on this too. Its simply not good enough. Happy to help you further if you contact me.

kcmoore

Thankyou very much alig123aileen. I have a feeling thr will be problems with this claim. We took out our policy in 2008, went in to bank to discuss it in 2013 as my hubby had given up smoking so it made our monthly payments a bit cheaper. I had no problems or was not under any investigations then. I was diagnosed with a valve problem in 2014/2015 something I was born with but never knew anything about quite a shock to learn at 30 and 2 children later!! What has really put me worrying is that I have a cousin in the UK that was recently diagnosed with MS she had the same critical illness cover but was refused as she failed to tell them in a certain period of time after she was diagnosed. When we went to visit our local branch to inform them of my diagnosis I mentioned my cousin and her MS and he said oh that is different and we don't pay out for MS something along those line's. I will let you no how it goes and might just need your help!

alig123aileen

Hi there if you put your grievance in writing you have a much better chance of getting a fair solution. Mention the ombudsman and insurers sit up and take notice and must put their final position to you. If you want help looking at your terms and condition I'm happy to help my background is claims in life insurance/ serious illness cover. And if you don't get the result you want go to the ombudsman and I can also help with that. I don't charge for this and given all you have been through on the health front it would be great if you could get your claim paid. Take care

kcmoore

alig123aileen Thank you so much for all your help with this you have bn a godsend. It's very intimidating when dealing with banks so it was so good to talk to someone who understands and knows what they are talking about. Highly recommended alig123aileen for any help and advice its bn a pleasure. Thank you :-)

kcmoore

alig123aileen Thank you so much for all your help with this you have bn a godsend. It's very intimidating when dealing with banks so it was so good to talk to someone who understands and knows what they are talking about. Highly recommended alig123aileen for any help and advice its bn a pleasure. Thank you :-)

Vim Fuego

If it's any help, someone close to me claimed on their critical illness policy a full year after a diagnosis - they had forgotten that they had the policy. Similar to you, there was something in the contract about notifying the company on diagnosis. However, there were no problems and everything went to plan with the payment. The insurance broker said that it was really common that people would claim quite a while after diagnosis.

I think it's natural to feel that something will go wrong but if you think about it, you paid for a product to do a specific thing (pay out in case of specific illnesses) and that is what is most likely to happen.

ANXIOUS

Am I the only one who doesn't see a grivence here? You are hypothetical thinking about a situation that hasn't occurred where you may have a grivence.

alig123aileen

I don't agree the lady has no grievance - if the lady notified her insurance company of her illness they should have sentbher a claim form within five days as this is compulsory via the regulators code of conduct for claims. The reality is Jo Public doesn't read the policy terms and conditions and high enough fees are paid by all of us to insurers and financial service companies for 'professional' advice. Insurers are ducking and diving and avoiding paying claims over technicalities that aren't even in policy documents yet quite happy to charge customers high fees for 'professional advice'. Against a background of a serious illness and all the financial hardship and worry and stress that can go with a serious illness diagnosis I think the lady who posted is quite right to feel concerned as she has been 'fobbed off' when she has asked re her claim. Insurers should be supportive and empathic which is rare these days.