Critical illness claim?

Munstermissy

Good evening. Currently reviewing life assurance and my policy which includes critical illness. I have policy in place since 2000. Was diagnosed mid 2000s with a long term illness. Only noticed last night that my illness is covered on their list.

I will be ring insurance company tomorrow but wanted to know if it is too late to claim on my policy? If anybody is in the insurance business, might let me know if I'm wasting my time claiming

Henry Ford III

It'll cost you nothing to ask.

Dempo1

https://www.boards.ie/discussion/2058213912/critical-illness-claim

Interesting question OP, I wondered how you got on with your enquiry.

I'd have thought if the illness is listed then your possibly covered my only concern ( I'm not an expert) is the inordinate delay in you making a claim, albeit I appreciate you were not aware the illness was covered. I'd have to assume there would be a presumption that you would have been required to put a claim in, with supporting documentation, medical reports etc within a reasonable time of diagnosis, just a guess mind you. I'm not entirely sure how an insurance company will handle this.

You don't specify if the life policy is attached to your mortgage protection but if it is, like my own, it's payout value has dramatically decreased in line with your mortgage balance.

My curiosity stems from a possibility I too may need to put a claim in, I'm awaiting a diagnosis. I've a 20 year old mortgage protection policy with critical illness cover, thankfully my remaining mortgage is low enough. I actually can't find any information on the my original policy (Irish Life) that states what illnesss are covered so will need to make my own enquires.

Hope you get sorted regardless.

Munstermissy

Hey Dempo, rang them during the week. I took out the policy in 2000 for life assurance and added critical illness to it. They advised that my condition was not listed on policy at the time I took it out. My condition only added in 2019 to their list. I asked why I would not be covered if they added it. He advised that it would cost more on my policy. I don't know if I was fobbed off, you know what insurance companies are like...

Will be cancelling the policy as will be in position to pay off mortgage in the next few months

Jim2007

https://www.boards.ie/discussion/comment/118069083#Comment_118069083

It is not clear to me what exactly your situation is. You stated that the policy was taken out in 2000 and included critical illness. Did the critical illness cover only cover specifically listed illnesses, the one you were diagnosed not being one of them?

Munstermissy

https://www.boards.ie/discussion/comment/118069169#Comment_118069169

Hi Jim, to be honest I lost the booklet that the original policy came with. I was checking online last week and saw my condition was covered on their partial payment illnesses, ie on their brochure. My question to them was if they added the condition surely I would be covered. Have paid policy over 20 years. Guy on phone said no.

Dempo1

https://www.boards.ie/discussion/comment/118069083#Comment_118069083

Morning, I'm sorry to hear this, I wasn't sure if you just had a life policy or mortgage protection /life policy with critical illness, like I have.

Whilst I'm no expert, I'd certainly seek professional advice before cancelling the policy particularly as your policy was active when additional illnesses added for coverage purposes.

Like yourself my own policy active since 2000, I would not have recieved a detailed list of actual illnesses covered but would assume 'Critical' covers a wide range of illnesses. I personally intend seeking a full list of illnesses covered under my policy ASAP.

Jim2007

https://www.boards.ie/discussion/comment/118069199#Comment_118069199

Probably worth getting some professional advice on this.

Munstermissy

https://www.boards.ie/discussion/comment/118070107#Comment_118070107

Thanks Jim, very stupid question now but what type of professional should I go to, insurance broker?? I did feel he fobbed me off when I asked why I would not be covered when they added my condition to their current brochure.

Dempo1

https://www.boards.ie/discussion/comment/118071548#Comment_118071548

https://www.fspo.ie/ these would be the people to make contact with.

My guess would be you may need to formally complain in writing to the insurance company initially, they will reply officially and from there you go to the financial services ombudsman, assuming you don't get a satisfactory response. Stay clear of brokers.

I would advise maintain the Policy until such time you get professional advice. Obviously there are no guarantees a complaint will suceed but after 20 years of premiums I would certainly utilise any options available by way of professional advice.

These matters are complex and will take time to investigate.

Good luck

Munstermissy

Thanks Dempo, no harm in complaining. I am persistent so will go the course with them.

Jim2007

https://www.boards.ie/discussion/comment/118069199#Comment_118069199

A solicitor.

Henry Ford III

https://www.boards.ie/discussion/comment/118071584#Comment_118071584

A good broker will be familiar with the claims record of your insurer, and whether or not additional illnesses are added to existing policies or not.

Advising against consulting one is poor advise in itself I'd suggest.

Dempo1

https://www.boards.ie/discussion/comment/118071743#Comment_118071743

I would agree normally but this is a 20 year old policy, its unclear if OP called the Broker or relevant insurance company and got a no answer but regardless if the insurance company is going to refuse a claim or dispute what's covered, the matter is really beyond what a broker can do for a client especially if there's a dispute regarding what the original policy covers and illnesses added after policy was taken out.

It's now a matter for the customer, Insurance company and likely ombudsman for a determination.

A solicitor could help but, they'd likely require Junior or Senior counsel opinion and at quite a high cost. It seems logical and in an attempt to keep costs to a minimum, OP engage directly with insurance company in writing seeking clarification and then move to ombudsman if necessary at no cost to them.

Munstermissy

Insurance is with bank of Ireland life. Rang them directly. He had to ring me back as it was not coming up on his system. Told me condition was not on policy at the time I took it out back in 2000. He said it was only added in 2019. My question to him was surely policy would be updated in line with any new add ons. His response was cover would be more expensive, yada ya... In my head thinking policy in place over 20 years, why would I not be covered.

As mentioned previously I think he fobbed me off.

Rket4000

It may come down to whether your illness was covered by the policy at the time you were ill.