Successful insurance claim for serious illness?

Sparklygirl

Hi all, My husband has recently been diagnosed with Cancer. We have Standalone specified illness cover from AIB and they brochure says that Cancer is covered and our consultant read the small print and assured us that he is covered. Does anyone know how they work out what to pay you, the cover is for up to 70k but we have no idea how they will calculate what to give him. He will be out of work for about 6 months and I am able to take 4 months of work to support him though this so we will be broke! Any advise will be gratefully appreciated,
Thanks
SG

Condo131

I am not familiar with AIB's policy. I had a policy with another co. and colleagues had policies with other cos. I'm also vaguely familiar, mainly thro' the media, with yet other companies.

One thing they all seem to have in common is a policy of stonewalling, avoidance and delaying tactics.

My advice, having been down the road with this, is to copy everything you send in. Date everything, and follow up. First thing to do is write (or email AIB - the address, if you haven't already got it, is here) and get a claim form. I suggest writing because there will be a record.

If at any stage you feel that you're being fobbed off, find out who's next up the line to contact about the claim. The documentation you get with the claim form should also contain details of what to do if you are not happy with the response. If you do (hopefully not) end up complaining, you will need to follow the procedure exactly as it says in the documentation - this is where you ask them for their Final Response. Only after that will the ombudsman look into your case.

I know I'm jumping MILES ahead, but, in my experience, there is a strong possibility that you will be going down this road.

I really peeves me :mad::mad::mad: that people who are seriously ill are treated in this way, especially when they already have so much on their plate!

You will need to keep paying your premium until your claim is (hopefully accepted). A|t that point, apart from the payout, you should be entitled to repayment of your permiums back to the date you submitted the claim.

I hope everything with the claim runs smoothly for you and your husband.

Sparklygirl

Thank you so much for your reply. This is exactly what I fear. I have completed the claims forms and attached the histology reports from the Doctors, photocopied them, scanned them into my computer (for emailing) and sent it by registered post. I am worried they will drag their feet on this and we are going to phone them on Friday. I think I will keep onto them so they move on it instead of dragging it out. I fear that if they do give us our claim that it will be after months of hardship fighting cancer and eating beans on toast!

Condo131

Crikey!! I just read the final para in their brochure: "We will alway seek to reach a decision within a maximum period of 6 to 12 months....."

Imho, that timescale is, way off the richter scale, unreasonable.

Yes I would ring them - get the name of the person you speak to, record time, duration of call....everything - and ask how long it will take them to reach a decision. It does take time, 2 to 3 months is not unreasonable - sorry I know you probably need it right now, but even with all the documentation, it takes a while and, as I said before, they do heel-drag.

Try to nail down an approximate timescale for a decision and chase after them. I recommend stepping things up, i.e. complaining to the next level, according to their complaints procedure, if you are set back at any stage. You do not want any crap at this time.

For the record, I had to complain to the ombudsman before my crowd (not AIB) settled....but then I got a bit extra because they fecked me about!

I suggest that either you or your husband, separately or together, contact the Irish Cancer Society, in confidence, on FREEFONE 1800-200-700, where you can talk to a specialist Cancer nurse. There are also the drop in centres. They also have a fund for assisting people (I don't know the qualifying criteria)

Sparklygirl

Thanks for your reply, I didn't see that small print (6 to 12 months) and I have looked at the booklet A LOT! However, it is probably human nature to see what we want to see. It will be terrible if we have to wait that long for a decision! Thanks for the advice, I will ring them tomorrow and I will keep an account of all phone calls etc........ I might even start the conversation with "for training and legal purposes, your call may be recorded" LOL.

I am sorry to hear that you had to go to such lengths to get your claim, I suppose, I should not be so naive since these companys are really there just to make money!

Condo131

I don't think you are bring naieve. You take out this type of policy and expect a payout if you are unfortunate enough to be diagnosed with one of these illnesses.

As I said before, companies are, in general, notorious for behaving badly when faced with a claim of this type. Its bad enough for someone in the fullness of their health to be arguing their case. It is *EXTERMELY* difficult for someone who is seriously ill to chase down these companies. Given the circumstances, I believe the behaviour of these companies is, very often, shameful.

I suggest that you should try to nail AIB down to a reasonable time limit for coming to a decision and, if they suggest a time-frame of 6 to 12 months, that you seek their "Final Decision" and kick it on to the Ombudsman.

"6 to 12 months" is NOT reasonable.

Sparklygirl

Thanks for your support on this Condo. We recieved a letter yesterday to say that they are contacting the Docs about the claim. Hubby is going to phone them now tomorrow for a time frame. I would love to contact them but I was informed by Arc insurance who are the suppliers of the insurance to AIB that they will only discuss claims with policy holders which is a bit rich when the policy holder is sick. Anyway, hubby will phone them tomorrow, thanks again for your advice.

Condo131

Sparklygirl wrote: »

..... they will only discuss claims with policy holders which is a bit rich when the policy holder is sick. .

Yeah, I forgot about that aspect. My crowd wouldn't talk to my brokers, so I had to deal direct. Initially, they wouldn't talk to my wife, even when i was present at the end of the phone, however we managed to get them to talk to her, as I was far too weak, mentally and physically, to argue things for any length of time.

Sparklygirl wrote: »

..... hubby will phone them tomorrow

If you, or someone else, can be present to listen in, it'd be great. Speaker phone can be a help, but tell AIB that it is on speakerphone.

Sparklygirl wrote: »

thanks again for your advice.

You're welcome!....been there, done that & got the t-shirt, so great to help smoothen the way for you, even if it's only a little bit.:)

JohnnieK

Sorry to hear that about your Husband. My wife is near the last of her treatment for breast cancer, We too have a similar policy with Irish life and it took about 3 months to receive the claim.
Her old GP was holding things up.

She received the whole 40K but she is not covered for serious illness any more on this policy.

The best of luck with his treatment and I know this might seem silly but try not to worry too much about your finances, it nearly had me ill myself stressing out about finances.

Sparklygirl

Thanks Condo and Johnnie. Johnnie you are right about not stressing over finances, and I am very fortunate in that my folks have offered to help out, it is just at 33 years of age, I would prefer not to be getting financial help from anyone, my folks gave me a wonderful childhood and encouraged me to go to Uni and I expect nothing more from them financially.

We phoned the insurance people and asked them if there was anything we could do to help the process, off course they said no, that they had sent the paperwork to the two doctors and were waiting for them to fill it in and send it back. We know our GP very well as we are regular customers since we have a 6 month old and a toddler lol so we phoned her and she had filled it out and asked us if we wanted to see it and add anything, which was great!

We apprehensively contacted the consultants secratary ( we didn't like to be annoying them as we don't know them well yet and also I am sure the consultant it more interested in curing people than insurance papers).
Well the secretary was wonderful, she checked all the post and emails and assured us that they had not recieved the papers, she remembered us as my husband is relatively young compared to the other patients ( it is v funny whenever they docs phone depts or dictate a letter they describe him as a young man- he is quite delighted with this!). So we phoned the insurance company and had them email the papers to the secretary, she phoned us the next day to let us know she got them (talk about efficient and we are public patients!). So at least we know the docs are doing their thing AND the insurance company know we are not happy to hang around.

Our GP and the consultant feel that we should be successful in our claim so we are hopeful. It is hard on my hubby as he is a sole trader and if he is not working his business will not exist, he needs to employ someone but if they don't pull their weight and make money he wont be able to pay them.

Happily we are starting treatment on Monday, I know it will be a tough road, but it will be great to start as it is hard to wait around for the inevitable.

Thanks so much for your comments

The Rook

Firstly, sorry to hear about your husband, Cancer deserves a kick between the legs.

If it helps, having worked in the Life Assurance industry for over 10 years in a previous life I can tell you that the majority of delays that we saw when processing a claim was solely down to the turnaround time of the GPs and consultants providing the relevant reports. We actually had a guy employed whose sole job was to follow up with GPs etc for reports. ("Medical Liaison Officer"!!)

I would think that all your paperwork would be processed very quickly given you seem to have everything in order ... we never liked to hang around on processing claims, so I hope you experience the same service.

best of luck for both of you for a long and happy future.

JohnnieK

+1 on the GP's. In my wife's case it was her old gp that delayed things or more so his incompetent secretary. My wife is a strong woman and didn't give her the time to breath so eventually they sent it in.

The insurance company rang her a few days later and told her they had everything and would report back with in a week which they did.

Sparklygirl

That sounds promising so. We just have to make sure the Docs fill in the forms.

Hubby had his first Chemo session this week and he is having Radiotherapy daily. Well he is in a heap and has been in hosp since the Chemo started. Seeing him like that made me think that if the insurance company don't pay out, I will not let it go The poor man is having a desperate time and my Lord if that doesn't meet their criteria then God knows what does!

JohnnieK

Don't worry about it!! everything will work out. I personally think that the stress and worry across the board in relation to cancer is the worst anyone could imagine, and that's from experience.

Everything will work out!!

Sparklygirl

Thanks Johnnie, but sorry to hear you have had experiance of this.

JohnnieK

Sparklygirl wrote: »

Thanks Johnnie, but sorry to hear you have had experiance of this.

We are at the other side of our journey thank God. And all going well this will just become a distant memory.