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.

CONTACT THE EMPLOYER.

It’s incredibly simple. You know you’re not still meant to have access to this policy, posters have given you lots of suggestions to deal with this, you’re just burying your head in the sand because you cannot be arsed to deal with it at this point.

If you’re concerned about legal action, a large insurance company have a much more expensive solicitor to take to court than your ex did.

You can’t have it both ways OP. If you cut ties with someone then you cut ties, end of. You can’t keep claiming on your ex husband’s policy just because it’s convenient, that is ridiculous. I too would love to still have access to ex-DH’s wealth but I got rid of him for a reason, you can’t keep trying to benefit off someone that you no longer have anything to do with, both morally and legally. Either get your own policy or get onto an NHS waiting list.

I'm sorry but I'm in genuine fear of my life if he gets angry again and if he ever found out I had contacted his company he would go mental.

He's already threatened me with defamation of character via his solicitor about 18 months ago when I told a mutual friend about the protection order (which I checked with my solicitor I was right to do and stuck purely to facts that I could prove in court) but he clearly doesn't want people knowing what a total abusive (insert word of your choice) he's become.

If I contact his company in any way I know that he will 100% go after me legally for damage to professional reputation.

You're still not getting it.

Its not for YOU to amend anything. It's for his employer. They need to know that you are now no longer his partner. If you wont contact them then get your solicitor to do it.

He may well have told his boss or line manager at the time & thought job done. But obviously HR have not followed through.

I'm sure once the right person knows you will be taken off the policy. But of course as you still want the cover in the meantime you'll just carry on as before.

I work in this area and the only thing I can add which might help is that PMI is an annually renewable product and therefore, every year he will receive details of who is covered on his policy, the case even for corporate schemes.

At that point, it may jog his memory and cause him to remove you (and this is normally around the financial year - so April time). Or, and given its a couple of years, he has stuck with his original 'promise' but in his angry, spiteful state and lashing out, made a statement to the contrary without understanding that it is a legal statement?

I'm slack at checking stuff but if he was determined to remove you and thought he had, he will receive detailed information at renewal that would make it very easy to check and also make it clear to him you're still covered.

As to the cohabiting - large corporate policies are so bespoke, there is every chance this isn't an eligibility factor for the cover and given the insurers know everything - I think you'll be OK to continue to claim.

Obviously, just a bod on the Internet - this is not financial advice 😁

I want my own policy!

But I can't remove myself as I'm not the policy holder! I've called and tried but the policy can only be amended by him. I asked the provided if I could be covered in the circumstances, and they said they could transition me when he cancels me but only within a 3 month window of grace.

All you have to do is say you want to be removed from the policy. That’s not grounds for any legal claim on professional reputation or anything else.

You can even instruct your solicitor to do this on your behalf.

You said you were worried about being sued, you’ve been told how to avoid that, you don’t want to. You’ve had a lot of helpful answers here, but don’t want to take them so I’m not sure what you were looking for making this thread.

Continuing to use a service that he believes is cancelled and that you wouldn’t be eligible for if all faces were known is potentially fraud. By continuing to use the policy you are leaving yourself vulnerable to legal action.

You do not have to contact him, you don’t even have to contact his employer directly, your solicitor can simply request that you be removed from the policy. No further detail required.

Many people receive annual.starements about pensions & life assurance policies & never read them from year to year.

I should know being a Financial Adviser for 35 years.

I do get it but I am not contacting his employer in any capacity as I don't want to have him argue I've damaged his professional reputation.

I self-represented during legal proceedings as I was quoted over £60K by the legal firm that were initially helping me in resolving it amicably without court proceedings, so I don't have any solicitors on file/retainer.

I don't think you understand the severity of his temper - my dad had to sleep on my sofa before the protection order was granted because we were both in fear of my life from him.

If you are in fear of your life then It is not worth it to sit on his policy knowing he doesn't want you on it.

I realise you have spoken to the insurers but have you told them about the full situation? You must be able to remove yourself from a policy if he doesn't have your consent to be on it. Escalate and ask to speak to someone more senior, the general customer service people won't know how to deal with this.

If they can't take you off then ask to set up a new policy with pre existing condition covered. Again this won't happen with the first line support but escalate until you speak with someone who can help.

You will likely be in breach of T&Cs, non resident adults are not typically covered in company policies. You can phone and ask that direct question if you want.

But if you are this fearful why are you continuing to take this risk? If you'd put yourself on the NHS wait list when it all kicked off you'd be at the top now ...

Have you asked the insurance company to contact your ex to ask him to remove you?

Thank you for this!

You've put my mind at rest. I will take the advice of some of the other people and get my name on the NHS waiting list just in case my financial situation does change as a back up.

The portal date at the top states I'm covered til April 2025 - which matches what you're saying and all the policy information only goes to him.

I don't see how it's fraud if I can't change anything and he continues to renew and pay for my cover. I get that the employer/T&Cs might say differently but as I can't be provided with them to check, I don't see how I could be at fault - I just needed to be reassured which you have done, as if he's stated he removed me 2 years ago then he would have statements in both April 2023 and 2024 stating I was still on the policy which he hasn't challenged.

This. You're no longer his dependant so I don't see how a work benefit would still pay out for you. There's been an error somewhere.

I’d get a solicitor to write to him to state that he needs to comply with the legal statement he made and remove you from the policy. It may not be against the terms of the restraining order for him to have you on this, but it is inappropriate in that situation.

You don’t need a solicitor on retainer to do this.

Im glad you’ve now said you will get yourself on the NHS waiting list. The worst outcome here is for you not to have sought NHS help and suddenly find yourself without private cover.

If you are going to continue to use the private cover, at the least I would get confirmation in writing (ie email) from the insurer that you are covered, and ask them in writing for the T&Cs - if they refuse to share these then keep that. But I don’t think it is a good plan to keep using it for now - you’re so afraid he’ll kick off in all sorts of scenarios, but it seems to me that him finding out you’re using is it the most likely scenario to piss him off.

I can't start an entirely new policy because my diagnosis won't be covered so I have to wait for him to cancel me and then transition to my own version of that same policy. The company will give me a 3 month grace period when this happens but the diagnosis will still be covered as its a continuation in their eyes and therefore not excluded as a pre-existing condition. Does that make sense?

I’d be very careful about this. This is exactly what AXA/MyHealthOnline told my DH when he was made redundant. We happily transitioned to a new policy with them but when he needed further treatment for an eye operation that had been done under the original policy they rejected it as pre existing. They said they were very sorry but they had made a genuine error in claiming that it would be covered as a continuation. As a ‘genuine error’ (bullshit) they were allowed to not cover the op and just give us a gesture of goodwill - a sum that was nowhere near the cost of the op. We made a complaint it got nowhere, apparently they can and do get away with this.

I don't see how it's fraud if I can't change anything and he continues to renew and pay for my cover

Trouble is it will be one of those ‘ignorance is no excuse’ situations. You know that you’re not his partner any longer and therefore may not be eligible. Even if you can’t change the policy. They take insurance fraud very seriously.

It won’t even be the employer, it’ll be the insurance company.

Can't your solicitors contact him?

Hi OP. I work in insurance and cover a large well known healthcare insurer. The contract for insurance here is between the insurer and the corporate firm. They in turn provide details of who they wish cover to be provided to. This will vary but would usually include Managers, their partners and in some cases children. If you are still listed as a partner, then you still have cover- you have done nothing wrong or illegal. The downside is that your partner can quite legitimately remove you at anytime and cover would cease. If you are in claim you could complete any initial claim at this point, but not make any further claims. It might be helpful to think about continuity of care. In many cases, if you have been named on a corporate scheme you can move to a personal product at an advantageous rate. The policy will usually have an excess, so just be aware your ex might be contacted and asked to pay for this, which might cas a flashpoint.

I understand you are concerned about your health, and want to continue to receive treatment.

But having a genuine fear for your safety from this man, can you not see that continuing to use this service on his behalf is absolutely foolish? I think a reasonable person would be pretty pissed off to know that an ex partner was still claiming on their policy when they had explicitly been told that their right to do so had been revoked (I understand that isn’t the insurers stance, but it has been documented that was his intention and you cannot claim to be unaware), but this is a man who behaves so erratically that you have had a restraining order against him. That’s the bear you want to be poking?!

I think the real issue is likely to be whether you actually ARE covered by his work policy given that you are no longer partners and don't live together. Policy wordings for health insurance provided by employers usually define who can be covered by reference to "wife/husband/civil partner" or person living at the same address as the insured employee and with whom the employee is in a romantic relationship.

So, whether or not he's taken your name off, it's unlikely that the policy still covers you and if the insurer cottons on to that, you/he will have a problem if they try to recover sums paid in respect of your treatment which should not have been paid because you no longer fit within the definition of who can be covered under his insurance.

Then get your solicitor to send him a letter. I take it your assets have not been split yet if this has not been discussed?

Burying your head in the sand will do nothing.

Have you got it in writing from the insurance company that when you are removed from his policy, you can keep the policy number? Given that it is his policy number, and a corporate policy at that, it's exceedingly unlikely that'll be possible unless they've found a special process to put this through.

It feels very possible here that you've been given well-meaning, generic advice from phone advisors, but that it won't be reliable for you.

Presumably if you cannot see the T&Cs, they also won't discuss anything with you - but get it in writing that they will 100% cover you when you are removed from his policy, for your existing condition, and that they will move his policy number to you to retain that benefit. I cannot see the benefit to the insurance company of doing this.

Out of curiosity, I've just looked back through my last four corporate policies, and all require anyone covered by my policy to reside at my address on a permanent basis. Anyone who spends more than 184 days a year away from my address, even in the absence of another permanent address, is no longer covered. That doesn't mean that it's the same for you, I've no idea if I've ever worked where your ex does, but it supports what people are telling you about the likely terms.

Have you got any of the advice that you can continue to claim in writing? Where you've made it clear that you are no longer in a relationship or co-habiting, and they've said that's fine? Or has it had to be a lot more vague than that to protect your current treatment plan?

I don't blame you for not wanting to contact his work, but this is quite messy.

There are various things that could have happened
a) he never asked for you to be taken off
b) he told someone at work to take you off but didn't follow the correct internal procedure for it to actually be done
c) HR/Payroll didn't action his request
d) the insurer didn't action the request from the company

If it is c/d the most likely time this will get picked up is during scheme renewal. If it is a/b/c and he is paying for the cover (or at least the tax on it) then he could realise at any time.

Unless it is scenario d, you being on the cover does cost him money as most schemes have different cost levels depending on single/couple/single parent family/family, and even if he doesn't pay directly for the cover he will pay tax on the benefit (either through payroll or a p11d).

Whether it has been used or not is irrelevant as the cost will be the same

But there is little you can do about it apart from tell him that you haven't been removed, at which point you can transfer the cover

Don't worry about it. You are legally covered by the policy until ex takes you off. The policy payments are made in advance until cancelled and no refunds will be made because he forgot to do it. So you using the policy while it is in force is not costing any extra as you are paying the policy excess amounts yourself.