Critical Illness Insurance

onimpulse

Hi Folks,

Just wondering if anyone has experience of claiming on Critical Illness insurance? I'm wondering what the normal time for a claim to be settled is - mine is going on for over a year now! It's been back & forth between the Insurance co & the hospital - each one blaming the other for delays.

Anyone have experience of this or advice on how to speed it up?


Thanks!

Condo131

Yeah! I know *ALL* about CI problems! :mad::mad::mad:

Critical Point: Your CI policy/contract is with your Insurer, NOT the hospital. The Insurer appears to be hoping that you'll just FO.

Sounds like you're getting 'the run around' from your insurer. I'm sure that you're already aware that the range of illnesses covered is quite limited and, even then, there are other 'hurdles' to be reached.

There was good deal of coverage on this topic on Joe Duffy about a year ago, with one particular company taking a load of 'flak'. My own experience was with another company and a friend had issues with a third company, who were still fighting him over payment, when he died of his condition! :mad::mad::mad:

So, imho, delaying and avoidance tactics are rampant in the industry.

In my own case, I spent approx. 6 months chasing the company and kept being told that "It's with the CMO (Chief medical Officer) for approval", then "It's been approved and you'll have the cheque in a week or so"....No cheque, and back on the phone "It's gone back to the CMO". This kept happening, so much so that I really doubt if it ever when to the CMO. In the end, I got a copy of the complaints procedures and also contacted the insurance Ombudsman. I received my payment AND additiaonal compensation for the "undue distress caused". I also got, fwiw, assurance that procedures would be changed and that nobody else would get the run around like I'd got. Is it happening? I don't know...but :rolleyes:

What to do:
1. Dig out your policy. If you don't have a copy, get one from the Insurance Company.

2. Check out that your condition is covered by the policy and that the severity meets the small print criteria.

....I presume that you've already done all of this.

3. Check out the Company's complaints procedure. Details should be included with your policy. If not ring up and ask for a copy.

4. Write to the Company's appointed Complaints Officer, asking for the Company's FINAL RESPONSE (*it is critical to use this phrase*) on the matter.

5. The Company then has to respond within 25 days. This is a Legal Requirement.

This should, at the very least, give you a clear picture of the status of your claim.

6. If you're not happy with the response, you can then refer the matter to the Financial Services Ombudsman. You CANNOT refer to the Ombudsman until you have received the Company's Final Response (or they have failed to respond within the legally stipulated 25 working days)

This is a copy of the Complaints Procedure from the Company I was dealing with.

This is the Ombudsman's Complaints Procedure.

When you're stricken with one of the Critical Illnesses covered, the *LAST* thing you want is hassle with this policy. You are probably *devastated* already - a Critical Illness is a Major, Major life changing event .... and then Insurance Companies put you through all this unwarranted, needless trauma! :mad::mad::mad:.

Hope this helps. PM me if you want any detailed info.

Edit: In my case, I submitted my claim in February 2008 and received payment in August 2008. I complained to the Company's Complaints Officer in early July, so payment came quite quickly after that. My advice is to go straight for their Final Response - you've been through enough unnecessary crap already, get them to do the work that they should have been doing.

...and...even if you are happy with their response and, hopefully, payment (plus, perhaps, compensation for the additional hassle), I would still recommend bringing the matter to the Ombudsman's attention - People in this situation do NOT deserve to be treated like this by the industry!!

cynder

My husband had testicluar cancer and within 3 months of diagnosis he recieved payment.

I have heard of companys giving the run around, so follow the advice above^^^^^

onimpulse

Thanks Guys,

Condo thats really helpful. According to my consultant I'm covered - he said straight off that they'd be back and forth numerous times as that had been his experience with other patients as well. It's not really acceptable.

Will follow your advice above and hopefully get somewhere!