Medical Insurance Pre existing conditions

[Eloise01]

Re: Medical Insurance Pre existing conditions

So assuming that this is PPI - I am still mystified, if there is no "policy" in operation why a claim was refused on medical grounds - then the OP cannot simply "cancel" the policy because they have "used it" and still owe the money for what they have had? They would have to, if it is possible, claim it as missold? Sigh!

[Bill-K]

Re: Medical Insurance Pre existing conditions

Glad you got my drift there, Turbo. Getting a 'butcher's' at the loan agreement and the insurance T&C's would be good. The former would establish if the insurance was PPI, and the latter would establish the policy term. The fact that Halifax didn't use term expiry as their reason for refusal has me intrigued - and is why I want to push for proof in that respect.

Meanwhile, even if it turns out to be a purely academic exercise, I believe the discussion here is worth continuing - perhaps in the wake of the much-publicised Nick Hughes furore...

http://www.guardian.co.uk/money/2013...life-insurance

...where the FOS reckoned: "While the firm [Friends Life] remains of the view that Mr Hughes did not disclose some things at the time of the application, it accepts that any non-disclosure was not deliberate or relevant to the claim he later made – so the firm accepts it was not entitled to rely on that and it should have paid the critical illness claim when it was submitted."

If the ONLY reason given for refusing Skyway's claim was an allegedly pre-existent condition, then perhaps we should look into this. If - as Turbo has (very importantly, IMO) pointed out - a pre-existing condition only affects any claim which relies upon that condition - then a polite little letter to Halifax, enquiring as to whether it would still be worth continuing with this insurance, might perhaps yield an useful answer regarding the policy's expiry date. The pieces of the puzzle are just not fitting together for me.

If it turns out that the policy WAS still in force at the time of the claim, then I think Eloise's suggestion of some 'Pro Bono' advice would be worth looking into. Nick Hughes' eventual payout was over £100K, I believe, so I reckon it is worth checking this out thoroughly before we fall back on mis-selling for a few grand. Sure - this is Parkinson's, and not Cancer - but the logic and principles are the same, aren't they ?

I dunno if this is relevant, but it springs to mind. A while ago, I received a Bowel Cancer test kit from our Local Health Authority, but I never quite got around to 'carrying out the procedure.' They sent me a reminder, so I got a bit angry and decided to accede to their request and send them a piece of excrement through the post - which is usually illegal, I believe - but had been politely requested in this case. Gorillas do have a habit of chucking this stuff about - so I guess I would be forgiven in this instance.

I was thus considered to be 'at risk' of bowel cancer, and was informed of this. In response, I duly sent in my sample for testing. To my surprise and joy, they replied thanking me for my sample, and declared that their tests had shown no positive indicators - even though bowel cancer was being SPECIFICALLY tested for - because critters like me are apparently susceptible to it. It was also made clear to me that this was NO guarantee that I was 'clear' of such a condition, and that I should continue to be tested as required. I was effectively told that I would continue to be at risk, but that BC had not been diagnosed at that stage.

Now - getting serious again - does this mean that I should have declared all of this if I had decided to take out a loan with PPI (Gawd forgive me) ? If so, then surely it should have been made clear to me that EVERY single morsel of data pertaining to my health should have been disclosed at the time of my application - just in case there was the slightest hint of a problem. Some years ago (well before the PPI scandal), I applied for medical insurance. A thorough and rigorous medical check-up was required, and I went along to undergo the usual indignities. But this was paid for by the insurance company - and so it should have been, IMO.

Contrast this with the 'slapdash' approach of the PPI brigade, and I hope it might be apparent that they are effectively relying on us poor punters to bear the onus for all this, instead of them. If they couldn't be @r$ed to pay for a proper medical appraisal of the Proposer at the time of the 'risk assessment,' then they themselves should be held to blame for this omission, and NOT the Proposer, IMO. How can they now insist that we should have provided our ENTIRE medical history (boils on the bum, and all) - when they did NOT make that clear at the outset ?

[Bill-K]

Re: Medical Insurance Pre existing conditions

So assuming that this is PPI - I am still mystified, if there is no "policy" in operation why a claim was refused on medical grounds - then the OP cannot simply "cancel" the policy because they have "used it" and still owe the money for what they have had? They would have to, if it is possible, claim it as missold? Sigh!

Let's be clear - that is still an assumption - but in all fairness to Turbo, it sure looks damned likely.

To my tiny mind Eloise, it is indeed an anomaly that Halifax have refused to uphold the claim on medical grounds, when a simple "SORRY...TIME-BARRED" response would have been the simpler and safer 'get-out.' Particularly in the wake of the Nick Hughes furore, as I said. BUT - these lenders are having to employ hordes of reluctant and sparsely-trained erstwhile JSA claimants to try and emulate Genghis Khan, I believe. Sure - they will probably force many to give up, but the likes of Skyways will keep going.

IF the policy was still active at the time of the claim, then we need to get written confirmation of that.

If not, then I would be interested in what they have to say !!!

You haven't missed anything, Eloise. PPI is like Fraggle Rock versus the Muppets, most times.

I am currently working on the assumption that this is NOT PPI - but perhaps a stand-alone medical insurance policy. I believe we need to get that aspect firmly nailed down, first. As Turbo implies - he deals in facts - and we need to establish those, don't we ?

If it turns out that it IS PPI (which I reckon is probably the case) - then your question is indeed the mother of the answer, in which case we are all barking.......up the wrong tree !!!

[Eloise01]

Re: Medical Insurance Pre existing conditions

I do hope that the OP doesn't mind my asking all these questions on his thread, and isn't simply getting more confused than they started off! I take Bill's point that the employees selling and dealing with claims may be less than well trained or competent (try talking to the ACAS helpline - you get seven different answers from five people! Conceivably all wrong although by the law of averages they should get one or two answers right!). And I agree with Turbo that we need to get the facts right - the OP is clearly confused themselves about what they have bought and what it offers. I may not think that what these companies are doing is "fair", but in my neck of the woods (employment law) this is often the issue - being "fair" and being "unlawful" are not the same thing, and that just life. But the case here seems full of inconsistencies ...

Anyway I shall stop butting in (unless I think I have something worth adding) but I shall watch with interest how this unfolds...

[TUTTSI]

Re: Medical Insurance Pre existing conditions

All I know that from a recent experience I tried for travel insurance for a trip to the far east with my Cancer condition, the questions were so not user friendly, when I asked the young lady to explain in more detail the implications of that question she could not so she answered everything in the adverse, I believe one of the questions was about proteins in the bloods, I did not have a clue about this as it is doctor/consultant question and I as a patient did not have a clue, the question was asked in about 4 different ways and it totally confused me - consequently after an hour she said sorry we cannot insure you have gone over on points. I could not see how she was answering the questions and for one question in particular she put down that a recent bout of Achilles heel inflammation she wrote down that I had had an accident when it was totally not true. So now after many calls to various companies and being offered TI at ridiculous prices and huge x/s I am just taking cover on an annual cover for travel worldwide with BUPA they are excluding my cancer condition but will cover anything else. I am stable at present and have been given permission to travel by my consultant and do not feel that my condition will stop me from enjoying my forthcoming holiday only the travel insurance nightmare. The insurance business is a total nightmare these days. I felt the question were also very insulting and also the people asking the question were not experienced enough to know what the questions meant and therefore they cannot be bothered and make it as bad as they can just to decline you.

[MIKE770]

Re: Medical Insurance Pre existing conditions

The other day I looked at travel insurane quotes just to update myself on possible cost, i.e. single journey say 6-7 months, a large list of we cover the following with out notification:- incl hip replacement,
then you answer existing conditions/medication, i.e. stemps, then have you attended hospital consultant in last two years, so you state yes - hip operation, then it goes and ask a load of questions, the price then goes up, (Ah! we cover the following (Hip replacement without notification),as you say insurance industry is out to get a lot of income and no cover using clauses?

[Inca]

Re: Medical Insurance Pre existing conditions

Can I just say.........Turbs/Bill/di30.......I'm really interested to see how all this pans out..I'm a total novice on stuff like this and you're all making it make sense. I do so like having clever friends

[Angry Cat]

Re: Medical Insurance Pre existing conditions

Hi, sorry to hear about your problems.
Whilst generally posters are querying Policy wording and general PPI problems, I'm more interested in seeing the actual wording of the proposal form and the answers given.
Halifax are claiming non disclosure, but if the questions weren't properly phrased, or the answers perhaps completed by the salesman for OP to sign they could be wrong.
Drafters of proposal forms and policy wordings aren't necessarily as good as they think, and they do make slips which get past their legal advisers.
If you haven't a copy of your proposal ask Halifax for a copy of the SIGNED proposal you made, and any promotional material used at the time, so it can be examined.

?To my knowledge I am unaware of any Bank providing a proposal form re: PPI?
I have never been provided one?
Normally, one just signs or, ticks a box.

[des8]

Re: Medical Insurance Pre existing conditions

Tuttsi, thanks for that last post. A great example of why, if this case progresses, we need to see original signed proposal. I have seen many cases where an agent (working for the insurers) has not completed the form accurately, but the proposer will just sign the form without correcting it because they think & accept the agent has filled it correctly. It is all to do where and when the form was completed and the competence of the (largely now a days) untrained agent,

[Angry Cat]

Re: Medical Insurance Pre existing conditions

I have to go out but will throw the following in the pot, for what its worth:

We know that the policy was taken out in 2007, when Halifax was part of Halifax/Bank of Scotland. Therefore, the original PPI policy would have been an HBOS policy underwritten by ?
We also all know just how irresponsible and reckless Bank of Scotland were and what happened to them in 2008...!

HBOS was then bailed out by us, the taxpayer, and Lloyds TSB plc were made to take on by Browns Government, the ailing HBOS problems.

Anyhow, the points that I am driving are:
I do not think that any sane person could consider that the manner in which HBOS conducted their business in 2007/08 was responsible nor respectable and;
that there must have been a change in the PPI policy plus the insurer/underwriter when Lloyds TSB plc took over the credit agreement account.

[Angry Cat]

Re: Medical Insurance Pre existing conditions

Tuttsi, thanks for that last post. A great example of why, if this case progresses, we need to see original signed proposal. I have seen many cases where an agent (working for the insurers) has not completed the form accurately, but the proposer will just sign the form without correcting it because they think & accept the agent has filled it correctly. It is all to do where and when the form was completed and the competence of the (largely now a days) untrained agent,

Travel insurance is different as is motor insurance.
Banks did not provide insurance proposal forms re: PPI!

[Eloise01]

Re: Medical Insurance Pre existing conditions

Tuttsi, thanks for that last post. A great example of why, if this case progresses, we need to see original signed proposal. I have seen many cases where an agent (working for the insurers) has not completed the form accurately, but the proposer will just sign the form without correcting it because they think & accept the agent has filled it correctly. It is all to do where and when the form was completed and the competence of the (largely now a days) untrained agent,

And, to be fair, although there's no evidence whether the OP did or didn't, the general propensity of the population to sign this things they haven't read! I see this a lot in employment law. The whole "but you signed agreeing to this" / "but I didn't read it first" syndrome! I get that if you need the money then you may have no choice but to sign something, but all the more reason to read it first! It's like gambling - the house always wins and if you are going to gamble, then that should be your starting point for reason, not that you will win loads of money. People need to get wiser.... There's no such thing as a free lunch and they need to be far more careful about the things they enter into, whether it is debt or employment.

[des8]

Re: Medical Insurance Pre existing conditions

Hi AngryC.
When I first posted, and even now, we are not sure if this is PPI or stand alone medical cover. In my first post I did say we also needed to see the promotional material used.
This was because if this was PPI with no proposal the promotional material is important. If the promotional material is what you rely on and it is not accurate and not reflected accurately in the policy the insurer has a problem. I know this from personal experience some 20years ago when promotional material did not mention the policy's 12 month limitation on payout, but gave the impression it was open ended. Barclays were miffed when the judge agreed with me

[charitynjw]

Re: Medical Insurance Pre existing conditions

As others have mentioned, a very interesting thread.

The principle of 'utmost good faith' is a very one-sided deal, loaded heavily in favour of the insurance industry.
The important point, however, is that it enables the insurance company to 'avoid' the contract, in effect treating it as if it never existed.

The new Consumer Insurance (Disclosure and Representations) Act 2012
http://www.legislation.gov.uk/ukpga/2012/6/contents
should go some way in addressing the inequality.

For anyone interested, this is a good explanation, part of which I have c/p'd below:-

http://www.out-law.com/en/topics/ins...ess-insurance/

Non-disclosure and misrepresentationUnder English law, an insured is under a duty of utmost good faith. When someone applies for insurance he must volunteer material information, whether or not the insurer asks about it. If he fails to disclose (or he misrepresents) a material fact that induces the insurer to enter into the contract on the agreed terms, the insurer is entitled to avoid the policy entirely, which means treating it as if it never existed.
What is material is judged from the viewpoint of a prudent insurer, not the insured. No distinction is made between innocent, negligent or dishonest behaviour, and avoidance is the only remedy available. So, although in theory, the duty of good faith applies both to insured and insurer, in reality it is one-sided, as the only remedy operates against the insured.
The duty is set out in section 18 of the Marine Insurance Act 1906, although its principles have been developed and refined by case law.
For consumers, who may have little knowledge of insurance law, the rules have been softened over the years by voluntary industry codes, the regulatory regime and the Financial Ombudsman Service (FOS) which applies a “fair and reasonable” test to complaints brought by consumers and small businesses.
In January 2006, the Law Commissions of England and Scotland began a review of insurance contract law and, in 2009, put forward proposals to bring consumer insurance law more into line with current industry and FOS practice. In March 2012, Royal Assent was given to The Consumer Insurance (Disclosure and Representations) Act, which closely follows the recommendations made in the 2009 report.
The Act *(which is not yet in force) removes a consumer insured’s duty to volunteer information, replacing it with a duty to take reasonable care not to make a misrepresentation to the insurer before the contract is entered into or varied.
If this duty is breached, the new law introduces a range of proportionate remedies based on what the insurer would have done had there been no breach, such as charging a higher premium or adding an exclusion. Insurers would still be able to avoid the policy if the insured’s misrepresentation was deliberate or reckless.

*Now in force from 6th April 2013

Also http://lawcommission.justice.gov.uk/...-insurance.htm

[Bill-K]

Re: Medical Insurance Pre existing conditions

...I'm a total novice on stuff like this and you're all making it make sense. I do so like having clever friends

Regardless of who it is, Inca, we just 'jump in the pool' here. LOL - when we've got our knicks off, then none of us is THAT clever, are we ? We each just "Give a piece of our heart." Sometimes it hurts, sure.