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Laya Healthcare refusing to pay claim that is over 12 months old

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  • 27-04-2020 3:37pm
    #1
    cswestmeath
    Registered Users Posts: 5 ✭


    Hi All,

    Looking for some advice on this issue! Not sure if there is anything I can do!

    I have health insurance since 2007 and moved to Laya in 2014. Never had a problem until now, over the last 6 years, my claims history stands at €1,109 (not excessive for medical bills over 6 years) I even used the public system on occasion to reduce my claims where possible and yet this happens to me!

    In recent times (Covid 19 etc) everyone is finding it hard financially, I started looking into where we might be able to save some money to make life a little easier, when looking at different Health Insurance options I realised that I was actually covered for "medical devices" that I had always paid for myself.

    With this new information I contacted Laya and was talking to a very nice man who said that as the devices were purchased more than 12 months ago they would not refund me (even though I had valid insurance that did cover the devices at the time I purchased them), He even asked this manager if he could waiver the 12 months as it was a genuine mistake to no avail (but obviously they waiver it for some people or why would he bother asking).

    I know it's my own fault for not knowing what was covered etc. but as a customer of over 6 years who made a genuine error I was hoping they might remove the 12 month barrier on this one occasion with all that is going on etc, unfortunately they won't!

    My question is!

    As I had valid insurance on the date that covered the devices I required, have I got any comeback or am I left out of pocket because I missed the 12 month deadline?

    Thanks in advance for any info or help
    Tagged:


Comments

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    #2
    Henry Ford III
    Moderators, Business & Finance Moderators Posts: 17,694 Mod ✭✭✭✭Henry Ford III


    Read the terms and conditions.

    If they stipulate that 12 month period I don't think you've any hope tbh.


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    #3
    Bojill
    Registered Users Posts: 346 ✭✭Bojill


    There's usually a condition that all claims must be within 3 months of current policy ending.


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    #4
    homer911
    Registered Users Posts: 5,117 ✭✭✭homer911


    I've had experience in the past of going a little over the 12 months for a one-off claim and having it approved as a goodwill gesture. It sounds like in your case you are trying to claim for regular payments made over an extended period of time - I cant see them agreeing to that


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    #5
    alig1234
    Registered Users Posts: 29 ✭alig1234


    Can I suggest you write to Laya and outline the fact the poicy was in placve at te time and ask them to review their decision and if hyour complaint is not upheld you will refer to the ombudsman. this usually spurs them into action but you MUST put it in writing and ask them for their final say on the matter as you need this to go to ombudsman.


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    #6
    Bubbaclaus
    Registered Users Posts: 4,461 ✭✭✭Bubbaclaus


    alig1234 wrote: »
    Can I suggest you write to Laya and outline the fact the poicy was in placve at te time and ask them to review their decision and if hyour complaint is not upheld you will refer to the ombudsman. this usually spurs them into action but you MUST put it in writing and ask them for their final say on the matter as you need this to go to ombudsman.

    On what basis could they go to the ombudsman if the T&Cs state 12 months?


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    #7
    ArthurG
    Registered Users Posts: 1,306 ✭✭✭ArthurG


    Bubbaclaus wrote: »
    On what basis could they go to the ombudsman if the T&Cs state 12 months?

    None. This is the internet where things like facts (or reading the previous posts) can’t be allowed to get in the way of bad advice.


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    #8
    daheff
    Registered Users Posts: 5,853 ✭✭✭daheff


    ArthurG wrote: »
    None. This is the internet where things like facts (or reading the previous posts) can’t be allowed to get in the way of bad advice.

    You can always appeal a decision to the ombudsman. They can then decide whether you have a valid complaint or not. They could well say the 3 month timeframe is unreasonable and award in the OPs favour. Or they could side with the Insurer and say the OP is wrong.

    That's part of what their job is.


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    #9
    LostArt
    Registered Users Posts: 1,808 ✭✭✭LostArt


    OP, unfortunately the t&c's are clear, it's worth appealing to Laya but the Ombudsman will 100% reject your case.


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    #10
    long_b
    Registered Users Posts: 4,938 ✭✭✭long_b


    Sorry to dig up an old thread, but find myself in a similar situation to the OP.

    I know that NOW claims must be made within 12 months of policy end date, but I seem to recall having much longer to submit claims previously (like a number of years). Please correct me if I'm misremembering.

    If this was the case at the time the expenses were incurred, would the extended claim period not then still apply (no matter what the current conditions say) as these were the conditions in force at the time ?

    Thanks in advance !



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    #11
    MIKEKC
    Registered Users Posts: 1,143 ✭✭✭MIKEKC


    https://www.boards.ie/discussion/comment/121583619#Comment_121583619

    The 12 month rule was there for a long time but was only enforced about 3 years ago. .Lost out myself on this. All decisions can be appealed. If this fails you can go to the Ombudsman. He prepared for a long drawn out procedure.



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