critical illness cover

[Piffyonarockbun]

i dont know if this is the right place to post or if anyone can help but im in a muddle.
in may this year my dh was diagnosed with ms completely out of the blue. he began having sore legs in april and due to his works private health cover he got diagnosed very very quickly.

he had critical illness cover through work so he put in a claim.

the claim was refused on the grounds that he had not had ms for six months. apparently if it is a personal policy this clause doesnt apply but as it is a group one he needs to be ill for six months. this was the only reason the claim was refused.

my dh spoke to them and they said that as a courtesy and to avoid him having to submit an entirely new claim they would write to his consultant on the date the six months is up. they have dated this from the start of his symptoms in april so this is due to be done on 23rd october.

dh is still suffering symptoms and has been left with permanent impairment in his legs due to the relapse. there is no doubt that in october his consultant will confirm he still has ms and has been impaired.

after all that my question is this: can they in october change the goalposts and come up with another reason to avoid paying out? they gave a reason to avoid paying out so if that reason is no longer valid should they pay up or can they say right, that reason is no longer valid but now we are refusing because of blah blah blah?

when he was diagnosed my dh had to give up his second job and lost a lot of wages due to sickness. i am on maternity leave but am going back in october as all our savings have been used up and we are in some financial difficulty at the mo. i just need a light at the end of the tunnel but im so scared they will come up with an excuse not to pay out.

hope this makes sense and sorry for no caps and spelling etc. typing quickly while baby is briefly occupied
tbh we are still in shock, he was diagnosed when dd was 3 months and its been a bit of a nightmare.
any help will be much appreciated

[mrsmalcolmreynolds]

Hi. I know this is a really stressful time but I believe a waiting period for cover like this after diagnosis is quite common - in other words I don't think they've plucked this out of the air.

If you are in doubt, then I would ask your DH's work to provide a copy of the policy terms so you can check it. Once the six months is up, they can only refuse to pay if there are grounds for that refusal under the terms of the policy. So again, you need to see what those are.

[Spickle]

Yes, quite common indeed. You do need a copy of the actual policy that your DH has to check that MS is one of the illnesses included in the critical illness cover and that your DH meets the requirements for the payout. For example, if you only took out the policy less than a year ago, that might stop any payout. They will almost certainly want the consultant in charge to validate the claim.

[Piffyonarockbun]

thanks for the help so far
we have looked through the policy and all the other conditions are met. they have only given one reason for turning it down. the six month period. he has had the policy for a few years and everything else looks fine. i was just concerned that once we got over one objection they might come up with another even though we can see he meets all the other criteria no problem.

[Spickle]

Another get out clause seems to be that if there is any way they think the critical illness is a pre-existing condition, i.e. that you have been seeking medical advice since before taking out the policy, but doesn't seem that this is the case here.

[Piffyonarockbun]

that was the one that we thought would get us
he did have an episode of optic neuritis when he was 12 (exceptionally young apparently) but has had no medical treatment for anything since. we were worried they might try and use the consultant also said that he would help us appeal if that had been the reason given the 20 year time.lapse bewteen the episode and the diagnosis. that.when they sent us the reason for refusal they stated that they would only take previous illnesses into account if the policy had been taken out in the last two years. he has had it for more than four years so we are well out of that. it literally came out of the blue. he said he had pins and needles in his legs for a couple of weeks and within three weeks of seeing the gp he was diagnosed. it was like a bomb going off!!

dh says that they would have to put all reasons for refusal in the paperwork and cant just come up with another reason later on but i jut wanted to make sure.

[Piffyonarockbun]

sorry. my post there is rubbish. the upshot beng the refusal paperwork confirmed that they would only use previous optic neuritis as a reason to refuse if the policy had been going for less than two years. it has been going for longer than that. that was the only other reason we thought they may refuse.
im just worried about them making something else up in october. i suppose it sounds positive. ill just have to wait and see i suppose.

[Spickle]

Phew, sounds positive so good luck with that. Financially it can be very worrying and it's worth taking a look at all the outgoings and seeing if there are any you can cut back on even if it's just temporary until you go back to work and/or critical illness payout.