Critical Illness claim - proof?

[Llioed]

I have submitted a claim for Critical Illness Cover due to being diagnosed with blood cancer last year. My cover started May 2014 when my husband and I took out our mortgage.

One of the questions at the time when we took out the cover was “in the last 12 months have you used cigarettes, cigars, nicotine patches, vape products?” To which my answer was no, I hadn’t used any products of that kind in the previous 12 months (not in 2013 or 2014).

I did used to be a social smoker (gave up around summer 2012) so when I started my claim with the insurance company last year (Sept 2021) they asked me if I had ever smoked, so I answered honestly yes, and they wanted an end date. I told them I was a social smoker (could go for weeks without smoking) but that I didn’t have an exact date as to when I had last smoked a cigarette. The man put pressure on me to say a date so I said “around 2012, or possibly beginning of 2013” but that I didn’t know. I did tell him at the time that I was a social smoker. I know now that it was around the time of the London Olympics because my husband reminded me that I was working in London just before it started and that’s around the time I last smoked.

The insurance company are now asking my doctors for an end date to my smoking, but my doctors can’t provide a date because it was never an addiction in the first place.

My doctors have advised me to call the insurance company and explain this again to them.

Has anyone else ever been in this position? If so, what did you do? I’m concerned they will make my claim null and void if I can’t prove this.

I wish I had said no to the smoking question when I started this claim process. I thought being honest was the best thing. 🤷‍♀️

Sorry to hear of your illness & hope you make a full recovery.

I used to be a claims assessor, albeit over 10 years ago so might be able to help.

First thing I would advise is to check with the company what smoking questions were asked in the application form, I.e., was it only “have you smoked within the past 12 months?” or did they also ask “have you ever smoked?”

If it was the latter and and you have already admitted you were a social smoker then I’m afraid it’s unlikely they will pay out. They will view it as material non-disclosure (rates offered at application stage would have been different).

However assuming you were not asked the “have you ever” question on the application form, you should ask your GP for a copy of your medical records to see exactly what information they have regarding your smoking habits.

Once you have all the information you can build your argument.

Best case scenario, you were only asked about smoking in the 12 months prior to application and there’s no record of any smoking habits in your medical records. In this case it would be reasonable & truthful to argue the claims handler put you under pressure to say a date you last smoked and now that you’ve had time to think it through logically you know you last smoked July 2012, London Olympics etc and not the start of 2013 as previously stated. The company has no proof you answered the application form incorrectly therefore should make payment.

If there is information in your medical records regarding smoking habits then so long as it’s 12 months or before the date of your application being signed then again you should be able to argue you filled out the application form correctly. It shouldn’t matter that your GP can not confirm when you stopped smoking - as long as there is nothing in your medical records to say you were a smoker after you completed your application form.

The onus is on the insurance company to prove beyond any doubt you completed the application form incorrectly.

Good luck with your claim and let me know if you have any other questions.

Hi, thank you for responding to my questions. To answer your questions…

The insurance company asked me 8 years ago “have you smoked cigarettes, cigars, nicotine products, vapes, in the last 12 months?” To which I answered truthfully no. I hadn’t used in the last 12 months prior. Insurance company did not ask me 8 years ago if I had ever smoked, because then I would have said yes, and the forms (all of my answers) would state this. They only asked about the previous 12 months.

My GP have no record of my social smoking status. They have gone back and can’t find any information at all that I used to smoke, so they told the insurance company that. There is zilch in my record.

I will speak to the insurance company on Monday. Thank you for responding, I appreciate this.

Hi Llioed, that’s all good to hear.

You might want to email the insurance company rather than call them so that way you have a paper trail of exactly what’s been said. Emphasise the claims assessor put you under pressure on the phone and you couldn’t think straight which is why you gave the wrong date, (perfectly plausible and in your case truthful), and it was only on reflection that you remembered you had your last cigarette during the London Olympics. If you can be specific of when, where and why you remember the date then it will strengthen your case.

As there is no evidence in your medical history you ever smoked then they have no evidence to cancel your policy and if your current condition meets the critical illness criteria they should pay your claim.

And lastly, you can go to the Insurance Ombudsman if you’re not happy with their decision, but I think it’s unlikely it’ll come to that.

Best wishes for the future.

Thank you so much for your help DonegalGhirl. I really appreciate you taking the time out to respond to my queries. I will send an email today to the insurance company detailing what I have said above.

I still have my work diary from 2012 so I will have a more clearer date as to when I finished work in London because I do remember my company wanted shop refits (in London) to be completed before the Olympics started. I know they didn’t want any refits being conducted whilst the Olympics was on because it would have been a nightmare logistically with merchandisers, contractors, building materials, etc, with the thousands of visitors and spectators in the area. Shop refits in London started up again after the Olympics finished, but I didn’t make it back down there again, work-wise as my company employed more people within the southern team (I was in the northern team)

Anyway, enough of me rambling on (sorry!) Thank you again, I’m really grateful for your responses. Have a great Sunday.