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.

What you want to is obvious. You want to conti Ur to claim for as long as possible and break a court order due to a technical problem.

All you're coming up is excuses. As if he'd more angry that you've contacted his company just to ask to me removed, which doesn't impact in any way his reputation over finding out you've continued to claim, including an expensive surgery whilst it was clear that was not his intention.

Writing to him would not be breaking any order. You just don't want to do it, all you are concerned about is not getting caught.

It seems madness that you cannot take yourself off a policy because you are not the named policy holder.

Can policies be rescinded retrospectively?

There's a difference between not being able to remove yourself, and continuing to claim under the policy without expressly telling the insurer that you are no longer co-habitant with the insured employee and asking if the policy will continue to cover you in that situation. Had the latter happened, the insurer would have had to have confirmed either yes or no. In the current scenario, if the insurer discovers the change of circs and reclaims the money, it will be a dispute between OP and her ex.

Also I don't understand the OP's reluctance to contact the insurer. Contacting the insurer is not the same as contacting his employer. I was covered for several months post-separation but pre-divorce under my ex's policy and I regularly contacted the insurer during that time as had a claim ongoing. The insurer doesn't share details of individuals' contact with the employer. They just aggregate claim details for the purpose of the renewal quote annually.

Also confused by the business about not being able to be taken off the ex's policy and transition to own policy. What is wrong with simply saying to the insurer: you have confirmed that you will offer me cover under a policy in my own name; I would like to incept that policy; my ex and I are no longer together and I am not in contact with him and cannot get him to remove my name from his work policy, however, I would like my own policy with you so please can you explain to me how I can make this happen?

This is incorrect advice. Being named on a policy does not mean you are covered, if the policy wording definition of who can be covered excludes the circumstances you are in, e.g. no longer co-habiting with the insured employee.

Likewise, on a motor policy you may find cover denied if you failed to report a change of circumstances during the policy term such as a conviction for a road traffic offence. It is the insured's duty to keep the insurer updated on changes of circumstances, not the insurer's duty to keep checking.

So I have liaised with the insurance company... I have clearly told them that the relationship has broken down and he has moved out the property. I asked them for my own policy and they said that I can't transfer my policy whilst I'm still active under his corporate one. This phone call was originally in Summer 2022 but they have confirmed it again today - they cannot remove or modify the policy at their end and neither can I - they only person is my ex-partner.

Again, as I'm not the policyholder, I can't update any changes to personal details or remove myself from the policy. It is currently in place until April 2025 according to the portal.

Like another person on this chain replied, said he has the power to cancel my cover at any time and no respective payments can be claimed off them if he does try to claim back any costs as he is sent renewal information on regular (they implied annual basis) and therefore should know that I am still being covered by his policy.

If he does cancel, I won't receive an update from the insurance firm. I have to check the portal regularly and update them if I realise I have been removed. They have stated I have 3 months grace period to then activate my own personal version of the same policy, of which payment would be recalculated at that point but estimated to be around £400/month (so that has increased since 2022!).

I have screenshot the online portal which clearly states that all policy details and T&Cs are only available to the policyholder.

Regarding someone saying about solicitors writing a letter - I haven't had a solicitor in over a year and self represented throughout proceedings due to the insane cost (they quoted 60K!!) and the civil legal case only covered the house and car. There was nothing about inheritances, pensions, insurances etc because we weren't married.

vivainsomnia I am not breaching any court orders - the protection order is stop him coming to the house and/or harassing me. If I initiate contact with him in any way (email, text, phone call etc) then it would give him reasonable grounds as a legal defence as I reached out to him. I got comprehensive legal advice on this when the order was initially granted and I cannot initiate contact with him. I had a family law solicitor when the order was first granted and this was one of the things they really emphasised to me. I appreciate you might have never been in a similar situation but your tone was unkind. I would already be on my policy if I could, but I'm left waiting for him to realise I'm still covered and then transfer when/if he does cancel my cover.

So ask his insurer to contact him to ask him if he still wants you claiming on it.

But you aren't "transferring your policy". The policy is his employer's work health insurance for employees. It's not a policy for you. You would be incepting a new policy with the same insurer. Why can't you do that regardless of whether or not he takes you off his work insurance as a named insured?

The OP has not entered into a contract with the medical cover company so I can't see what basis they would have to take action against her, especially as they refuse to let her see the terms of the contract they have with her ex.

Read the OP's posts. She has tried to take herself off the policy, the company won't let her!

You're not committing fraud. Every year, he'll be told that renewal is approaching by his company and given the option to add or remove dependants. He's chosen not to do this.

Your membership guide on the portal will explain that the contract is between the employer and insurer and changes to the policy can only be done via the employer.

Once he does remove you, as you know, you'll have 3 months from the cancellation date to buy your own policy. Your policy can be loaded to cover your current condition on a continuation basis, and this will bump up the price. You're likely to be underwritten for a few months for any other, new conditions that start after the new policy start date. If you have any exclusions on the current company policy, they'll also be carried over.

@ongoldenpond the legal cause of action would be unjust enrichment, i.e. taking the benefit of cover you are not entitled to. Though the OP says she has told the insurer that she isn't co-habiting with the insured employee any more so you'd hope that if that means she isn't covered, they'd have told her. I wouldn't rely on whatever a phone jockey has said though - I'd want it in writing from the insurer that cover continued regardless of co-habitation status.

@BlairW You said that you do not have a solicitor, but you can contact any solicitor and ask them to write a letter.

It is for your ex's benefit as he will be paying tax on your part of the premium, so I can't see it being an issue for the NMO.

There may also be an excess on your policy (although I know all policies might work slightly differently). I have PHI through my employer and each person on my policy (me, DH and DD) will be charged for the first £250 of treatment each year. The year starts at the renewal date. I get an invoice for the excess - is this something you have been paying?

Yes the unjust enrichment could apply if OP had access to the T&Cs stating she no longer qualifies for partner cover and continued claiming anyway. But she didn't and it seems has fully disclosed her situation in the call.

I agree her best course of action is to send a registered letter outlining her situation and insisting the company either agrees in writing she is still covered by the policy or takes her off the policy to allow her to set up the follow up policy with them as she requested.

Actually no, a successful claim for unjust enrichment would not require her to have had access to the ts and cs

@Elektra1 that's interesting that you can be sued for inadvertent wrongdoing even though you requested the information needed to alert you to the situation. Would getting written confirmation from the company that she is covered in her particular situation protect OP from such action? Would seem extremely unjust if not.

If she could prove that she'd told the insurer they were no longer co-habiting (i.e. written proof not just a phone call) as soon as they stopped co-habiting, and that the insurer had told her she was still covered (in writing, not orally), then yes that would be a defence.

Of course, financial services companies, including insurers, record calls and those recordings would be disclosable in litigation but being realistic, a private individual would be ill advised to get as far as disclosure in litigation against a large corporate - with the associated costs risks - without being absolutely certain of what would come out in disclosure. And that is very rarely, if ever, the reality.

Presumably a private individual wouldn't have to get as far as disclosure because they could just do a SAR for their personal data, and this would surely include recorded phone calls they had made and the insurance company had kept?

All that said, when i was covered under my ex's work insurance, I had a copy of the policy terms and i dealt with the insurer for my and my children's claims without reference to my ex, even after we separated. So perhaps different insurers have different policies about provision of their terms to those covered as named insureds.

Either way, it's fairly well known that work health insurance doesn't just cover any person the employee chooses to name, and is limited to partners with whom they co-habit, and their children and step children (usually up to age 24 or when they leave full time education, whichever is sooner). The onus is on the insureds to update change of circumstances.

@ineffable23 unfortunately responding to SARs gives corporates plenty of "outs" as to what does not have to be disclosed and without going into the ins and outs of all of the circumstances in which things don't have to be disclosed, i certainly wouldn't rely on this if i was looking to avoid being landed with a bill for medical treatment I'd had but wasn't entitled to have paid for by an insurer

This.

If the OP wanted to she could ask the insurer to take her off his policy, when they refuse she can simply ask them to set one up for her, in her sole name, on the same basis as the one she is on now. There is no crime in having 2 PHI policies running at the same time ad long ad she only claims on one.....in this case her new one.

I'd be interested to see what their stance on this would be.

Is it possible he made the sworn statement saying he has cancelled because he planned to cancel but when it came to it, he realised that despite the horribleness between you, he felt he couldn't go through with it? Perhaps even out of some kind of superstition in bringing bad luck to himself?

Or even to have that feeling of you always being indebted to him?

Well the presumption from the insurer is that the named policyholder would be sharing all relevant details from the t&Cs. They've provided those t&c already and it's not really their problem that OP can't read them. Seems like they could be entitled to say well we provided them to the named person and those insured are responsible for reading them. Or something to that effect.
It's normally company specific as certain employers may have limits etc so I can see why they don't provide to anyone who asked. They also are changed sometimes year on year so they are normally reissued every year to policy holder. So even if OP had a copy from a year or two ago, they may change. That's the problem with the company ones, the company can even just change insurers too which would leave OP in a pickle