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.

Not sure if this mentioned already but I think you might be missing a key point of how workplace insurance policies work. In every employment I've had in the UK, they are managed through my workplace benefits portal. The portal also manages dependents either at account level (I can add dependent to my account ) or benefit level (I specify which dependents a specific policy apply).

This benefit is included in my benefit package so I don't have to do anything for it unless I want to upgrade or opt-out.

For the first time this year I have used the policy and accessed my account on the provider portal itself. But before that for the past 15 years I have NEVER had to access my policy via the insurance provider. All they do is send me a letter at the beginning of the year so I know which provider it is.

Given that HR is often absolutely rubbish at managing those things, even in major companies, it is absolutely possible that your ex did remove you from the policy on his end, through his employer portal, but the employer did not communicate this to the insurer.

I have no idea what the implication is for you using the policy, but I'm wondering the insurer could claim the money back if it appears the responsibility lied with the employer to update their records.

re “Not sure if this mentioned already but I think you might be missing a key point of how workplace insurance policies work. In every employment I've had in the UK, they are managed through my workplace benefits portal.” I’ve had insurance in three workplaces and have never done this. The workplace has paid for them but I’ve had my own login and even been able to change the email address if needed.

i think people need to stop assuming that their workplace insurance is the same as someone else’s. There’s a large variety on offer and they all have different terms. The exP here may have been allowed an additional named person and it doesn’t matter where they live, in which case the OP is fine. As the policy holder it is surely just up to him to know.

that's interesting that you can be sued for inadvertent wrongdoing even though you requested the information needed to alert you to the situation
But in this case, it was specified in a court order which she had access to, so how can it be argued that she didn't know the terms, when the terms were that she wouldn't be entitled any longer on his membership?

So I think your mixing up legal phrases but to be clear there is NO mention of the health insurance in any of the court orders.

He stated in a witness statement earlier this year that he had removed me over 2 years ago but provided no evidence to support this and this contradicted multiple statements that he made saying he would keep me on it for 'as long as needed'.

All the excess payments come directly to me to pay from the private hospital/clinic and its extremely clear when you log onto the private healthcare portal that I'm still covered.

But if the witness statement was shared with, it can't be argued that you didn't know. Instead, it raises the question of why you continue to use it.

Because I've checked with the company and they said that's not the case and I'm still covered

I understand what the insurance company have said.

I don’t understand why you continue to use it.

Appreciate you might not have read all the messages but I can't get my own policy until I'm released from his current policy that covers my medical diagnosis from just before we split up.

If I start a new policy, the diagnosis is classified as a pre existing condition and therefore not covered.

Apologies if that wasn't clear but I tried to make the initial post clear.

It's pretty clear. But I think if I was in your position, given the background and ex issues and fearingfor my life, I'd be escalating to as high as possible with the insurance company to get a new policy in place rather than waiting for him to remove you.
That's the bit I don't understand, of course the first line customer service agents will say what they said, but I'd keep escalate until you speak to someone who can actually help

Well, that's just one of the consequences of splitting up with him. You dont get to keep the good & not the bad.

In most Life Assurance & Criticall Illness policies there is a "separation" clause that says if you have a joint policy & you split up then you can start a new one with that provider on the same terms as the original. Therefore no underwriting & no exclusions.

This is similar to what you are trying to achieve but you need both participants to agree. I understand you do not want to poke the bear but you cant have it both ways.

Forgive my ignorance, but would you not just message your ex to say you seem to still be on his policy and can he please remove you so that you can set up your own?

OP why are you still living there? It's not safe for you, so sell up and move somewhere XP doesn't have your address. That's important to reduce your stress levels, to help keep you as healthy as possible.

All the excess payments come directly to me to pay from the private hospital/clinic and its extremely clear when you log onto the private healthcare portal that I'm still covered.

Ignorance of the law is no defence though, is it. If you know the cover is based on incorrect information provided ie you're down as a spouse. Then the insurance is obtained fraudulently. The fact some admin assistant hasn't flagged up this fraud when you've reported it, doesn't mean the fraud isn't happening.

Having said that, the money the policy is costing the employers is probably small fry to them. One day when he goes to add someone else to it, they'll assume he's split up with you if you're listed as spouse/DP and remove you.

I doubt very much they're even going to notice you've been claiming, much less sue you for it. If XP thinks he's removed you he probably has told his employer he's split from you, so the error is probably the employers that you haven't been removed. Honestly, most people aren't very! If an employee discovers you've been claiming long after he split from you, it's not that likely they'll raise it with anyone, because it's not their personal money and they won't really care. They have to work with their colleagues and won't want to cause someone to get in trouble for not having cancelled you ages ago. The person removing you could even be the one who was supposed to cancel you, so even more likely to cover up the fact it wasn't done by quietly removing you and saying no more about it.

In your shoes, faced with options of
a) continuing to claim on this policy,
b) going with NHS or
c) taking out your own policy that excludes this condition,
I'd continue as you are and stop worrying about it.

I'm guessing you can't afford the £4k for a new policy and pay the full price yourself for treatment/monitoring of this pre-existing condition. So in the event that you can't stop worrying about it (stress being something that makes people ill), I'd stop having private insurance, pay privately for this condition only and use NHS for anything new that crops up.