Can I be sued for using his insurance?!?! HELP!

[BlairW]

So it's a bit complicated so please bare with me!

My now ex-partner (not married, but living together for over 10 years) covered me as part of his work private medical insurance scheme when he started with with current company years ago.

Roughly a year before we split up, I was given a major health diagnosis (not cancer) but now need regular scans, bloods, consultant reviews etc +/-medications depending on multiple factors.

When we split, my ex partner acknowledged the fault was his and that he would continue to cover me on his private policy 'for as long as I needed'. I did tell him that this could be lifelong and he looked uncomfortable (probably guilty conscious) but seemed to agree.

Fast forward a few months... the amicable nature of the break up went up in flames when I said I wanted to buy him out of the house as my mortgage had been approved. He went crackers - threats, stole legal documents from the house whilst I was at work, intimidated me near the house dressed in black.... basically long story short - the courts got involved and it has taken years and cost a bloody fortune!

The house is now mine and my next series of scans/bloods are due. In a court statement he gave during the proceedings, he stated that he cancelled me off his private policy shortly after I qualified for the mortgage several years ago.... but... and this is the legal issue.... he hasn't. My policy is very much still active and has been since he initially covered me many years ago.

I've spoken to the private provider but they are unable to do anything including remove me from the policy, as only the main policyholder can make any amendments.

Will I get in trouble legally if I still use the policy? Could he someone claim against me?

I have looked at going with another provider but they won't cover pre-existing conditions, and the same private company will transfer me to my own personal policy within 3 months of him cancelling me off his policy if/when that happens.

You're still insured. They know the situation and have confirmed you're still covered.

So you have nothing to worry about.

If you're on the policy then you're on the policy. Unless it says in the policy t&Cs , which the company can advise, that you have to be cohabiting or something then you're covered.
However, the address on the policy may now be his address and then he'd get letters or emails about your claims and health conditions potentially sent to his new address which he may open.
Personally I'd escalate within the insurance company and tell them your coverage under his policy is not with your consent and try to remove yourself that way. In the meantime, can you see your GP for this bloodwork? Be aware that privately paying for health insurance with pre existing conditions is very expensive so it may be helpful long term to get on the nhs books

So to be clear - I'm not worried about the provider/being covered. The provider has just approved my next series of tests and consultant review.

The annual excess payment letter comes to me from my private specialist - not from the medical insurance company.

I dont think my ex partner is either receiving or reading his statements as he would have seen I've had loads of treatment (likely 5k in total) since he claimed he cancelled me on his policy.

NHS isn't an option - it was an 18 month wait for even the first review and I need bloods, scans and most importantly eye tests (given my job) every 3 months.

The private company said they don't have the power or legal right to modify a policy - the only peson who can is my ex,

I'm worried about T&Cs and his reaction when he/if he finds out. I can't access the policy or the T&Cs on the portal as an 'extra member'..... could I get sued if we don't live together? Even if I've never seen or had access to the T&Cs??

Did you post this yesterday? I'm sure I've read this previously.

On what basis is he going to sue you? It sounds like the insurer is aware of the situation and hasn’t invalidated the insurance. If he wants you off the policy he can take you off.

If he wanted to take you off the policy he would do, he hasn’t so keep using it.

I don’t see really what the legal issue is, he’s the policy owner, you’re not using it without his consent because the ability to remove you lies with him.

OP has two duplicate posts with different titles. OP, you should report the one with no replies and get it removed.

I'm worried about T&Cs and his reaction when he/if he finds out.

This is an admin situation rather than a legal one, there’s nothing for him to ‘find out’ because he’s not removed you.

If wanted to remove you he’d need to contact the insurance company and they wouldn’t approve the appointments.

I don’t see that he could be angry at anyone except himself really, if he doesn’t want you on the policy he needs to do something about it and he hasn’t.

OP, my friend has private health insurance paid for privately and complex medical condition. Her annual policy is now £3k.
Get on the NHS waitlist now. Because even if you manage to keep on his insurance, one day he'll twig and I'd say if you can't afford the 5k cost of treatment then you may not be able to afford annual renewal. You've already said another phi won't even cover you. One day this will end.
As PP have said, if you can't access T&Cs and they've confirmed you're covered and you've been up front with them then there's nothing to sue about. You've not defrauded anyone, he's not out of pocket. But if he leaves his job or twigs it could end overnight.

You say as a ex member you don’t have access to the t&c.
But you say you’re on the policy so you’re not an ex member. If the policy is active , you should have access to the t&c. If you can’t find them just ask them.

Yes - I posted yesterday but nobody replied and then I realised the title wasn't very clear and I couldn't change it.

There are 3 key issues

1. In a legal witness statement, he wrote that he cancelled me off the policy 2 years ago. This is sworn, legal statement with a truth declaration in which giving a false statement can get you found for Contempt of Court. So I believe he did try to cancel me from the policy or thinks he has. This timeframe would match when his behaviour was escalating so it makes sense that he would have at that point - also I don't know why he would lie in a legal statement that the judge read about cancelling medical cover for your ill ex-partner as it just makes him look like an arse!
2. My ex has a nasty temper and has already taken me to court over the house (rather than mediation or solicitors talks) as he's a very spiteful individual at present. I am scared of the backlash especially as the NMO is due to end in the next week.
3. If the T&Cs do say you have to be living together, then he moved out almost 3 years ago. Could the company then sue me? Even though I don't access to the T&Cs?

I'm a current member but I'm an 'additional' or 'extra' member.

Only the main policy holder (my ex partner) has access to the T&Cs

I would say its his employers issue if its bia his work. How does he pay the premiums? Himself by direct debit or deducted from his salary ?

You need the T&Cs.

I’d imagine that if you’re breaking them, they’d sue him and he’d countersue you, but there’s no guarantee of that. If they’re saying you can still use the policy, they need to provide you with the T&Cs to be able to do so.

He obviously believes he’s cancelled it, but it doesn’t seem he has. I wouldn’t be concerned with that.

My initial concerns would be that the paperwork will go to him, including any treatments you’ve had; and that you can’t see the T&Cs to see if you are complying with them. I wouldn’t be worried about him. He may kick off but it’s his failure to remove you. As long as the T&Cs don’t have any clauses around being in a relationship/living together/rtc, you’re not doing anything wrong.

My major concern would be that it’s clearly an accident that you are still on his insurance and he is likely to find out soon, which is very likely to mean he removes you immediately. Have they told you what they’ll quote you to continue your cover? Is that affordable? It seems that you're on very thin ground at the moment with this.

To answer your questions

1. Is his problem not yours. He made the statement but didn't do it.
2. He can try to take you to court but he has no basis. He is not out of pocket here and has no costs incurred as you've paid these.
3. Typically you have to live at the same address to be eligible for partner/family cover as an adult. However if you have phoned them and explained the situation and they have confirmed you're covered under policy again there's not much you can be sued for.

As I said in my previous post, that this cover could stop abruptly is the main risk for you.

To answer your questions;

1. If he’d taken you off the policy you wouldn’t be able to use it. If by some odd chance he has tried to and the insurance company has continued to let you use it that’s their mistake.
2. His anger can only be directed at the insurance company or himself for not making the change correctly
3. How have the insurance company been communicating with you? Call them and ask for a copy of the policy, if you’re named on it you should have a copy in any case, you could he asked a question about it by the hospital - just get a copy of the T&Cs, but even if this is the case it’s something the insurance should’ve clarified, and unless you’ve lied when asked I don’t see this is an issue

So I can afford the private cover (which I am grateful for!) but I can't remove myself from the policy.

If I started a new policy, then my condition would be excluded as it would be consisted pre-existing.

I check the online portal semi-regularly as if/when he does cancel my cover, I have 3 month period to transfer into my own policy where it would be covered but costs roughly 4k/year.

I have no plans of going with the NHS for this condition as the waiting list is so long and the services are already overstretched.

Well then if you can afford to stick with this phi, then just check the online portal every 3 months. That's all you can do as you can't remove yourself. I don't know if you tried my other suggestion about telling them he doesn't have your consent to add you to the policy?

It’s very complicated, on my policy I have my 2 adult sons, they had to sign papers to say I could deal with them and vice versa. There is hardly any paperwork that gets actually sent with private healthcare now, it’s all on line and yes they won’t provide you with any paperwork as you are not the policyholder and I doubt your ex would check his online portal unless he needs to, but he may never have access to your records, as in our case, all members have separate log ins. You’ve spoken to the insurers who have confirmed all your treatment is covered, it’s down to ex or his employer to check that all information on policies is correct. They record, well they do in my case, all telephone calls, so you have this. I expect ex thinks he cancelled as he isn’t actually paying for you, but his firm are.

1. Thanks - I think that is what has happened as I can't see why he would declare he had removed me and given a specific date of doing so unless he really thought he had.
2. Not how he works - his took all his anger out towards me when he realised I could afford the house without him. I'm not a counsellor or a psychologist, but theres definitely a pattern that he directs the anger towards me and doesn't take accountability himself.... it got so bad before the Restraining Order was granted that my dad had to sleep on my sofa for a week and I woke up with a brick in my driveway....really upsetting and very different to how he was when we were together.
3. I have no communication from the insurance company. I call them when I need approval for more tests/reviews on a hotline. I have never received any documents from them directly. I have an annual excess to pay of approx. £100 but the hospital contact me directly for that. I've asked for the T&Cs but been declined as I'm not a policyholder and there are no T&Cs on the online portal to view as it's restricted to the policyholder login.

Document all the conversations where they say you are still covered. Worst case the insurer tries to reclaim their costs for the period the terms of the policy were breached by you no longer living together.

I agree very much with the last point, sooner or later your ex will remove you from the policy, at which point you need a back up plan - it seems to me highly unlikely any insurance company will take on an ongoing issue with regular claims / ongoing claim for less than they are actually paying out, so you could find the premium is as much or more than it would cost you to pay yourself, the only benefit being they would be taking the risk of this increasing.

Well thats one thing I worried about - as I cant see the T&Cs I don't know where I stand.

One of the team I spoke to before, said your policy is still current so you're fine as long as it is.... but I'm just worried about loopholes and my ex being angry enough to start another big legal case against me.

But it would not be your ex who would pursue you legally. They might contact him first but reclaim costs from you,

Are you on good terms (ie friendly) with your consultant, it is possible that the healthcare provider can see the terms and conditions and can show you.

Or could you make enquiries to the same insurer (although not under the guise of a existing insured) about taking the same policy and ask for the T&Cs, then just not buy the policy.