Medical Insurance Pre existing conditions

[Turboman]

Re: Medical Insurance Pre existing conditions

B]

2007-Home Loan Application, Secured Loan Repayments Cover and Terms & Conditions[/B]

Enclosed below are pages 1,2,5,6,7,8 from the 12/02/2007 letter re Homeowner Loan Application--[2 of page 6 with Skyways annotation]











Note above page 8


This is the formal acceptance by Halifax of the Loan Application




This is the Booklet for the 2007 Personal Loan Repayment Cover



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[Turboman]

Re: Medical Insurance Pre existing conditions

Documents relating to the Claim in 2013


These next 2 are reports of a private health assessment requested by Skyways Employers
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[not posted--but private assessments by his employer's selected medical panel confirm Skyways not fit for work]
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This is the crucial Doctors Statement that Halifax are relying on in the letter following

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The next 2 pages are the reply to the claim by Halifax--effectively upholding a claim on the 2003 Mortgage Cove [pre-the Doc's examination] and rejecting the 2007 Homeowners Loan Cover



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[Turboman]

Re: Medical Insurance Pre existing conditions



These are reports into Parkinsons which Skyways would like you all to assess



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[Turboman]

Re: Medical Insurance Pre existing conditions

Issues to Consider


The non-payment by Halifax of a claim is worth


A)---60 x 200 = £12,000 if claiming straight disability--£200 is around current mthly payment--ie £200 for next 60 months

B)---76 x 20 = £1,520 +8% on each pymt of £394 = £1,914 if claiming mis-sold

Sooooooo

As I see it we have 3 Senarios

1. We advise Skyways to cancel the policy and go for straight mis-selling.
2. We agree that Skyways has a chance of persuading Halifax to reconsider, and try to help him with the request.
3. We agree that Skyways has got no room for manouvre with Halifax and gently advise him to drop it--and go down the FOS route if we think it appropiate.

1. We advise Skyways to cancel the policy and go for straight mis-selling.

I personally am of the opinion that this is a bad reccommendation because

a)-Skyways is still insured for other conditions for Life on the remaining balance and other non-pre existing conditions that might occur in the future. ie he may die through a traffic accident or get cancer for instance. I'm not sure --but he may not be able to now get similar insurance elsewhere on the existing premium of around £20 pm.

b)-The most common mis-selling on unsecured loans occurs with a simple "tick" on a CCA (or added later by some unscrupulous lender-lol) and because the insured was told it was a condition of the loan.

However, neither of these are true as the insurance was effected by (after initial discussion in the bank) a comprehensive pack was sent out to Skyways on 12th February 2007 and he had the option of declining it or going elsewhere for it.
[The pack is in post 106 above--but Skyways does not have the Initial Disclosure Document as mentioned on page 2]. Page 8 of that document also states that Halifax did not advise on the product but that Skyways requested it. Subsequently, Skyways signed this appication and returned it after having had time to consider all the facts of the insurance

1. We agree that Skyways has a chance of persuading Halifax to reconsider, and try to help him with the request.
   
2. We agree that Skyways has got no room for manouvre with Halifax and gently advise him to drop it--and go down the FOS route if we think it appropiate.

In order to focus people's mind on the above issues--I draw your attention to the following:
6 & 7of 20 in the above post re the documents supplied for the application dated 12/2/2007--whereby thy say they will not pay benifits re any pre-existing condition or chronic condition

Also page 8 of 20 where they say they did not reccommend any product


Also the 'pre-existing conditions' statement on page 7 of the Policy Terms and Conditions

also the letter of 4/6/2013 detailing the reasons why the claim is rejected

Also I have documentation for annual reviews re PPI whereby they suggest web sites to check to see if same cover can be obtained cheaper


These exchanges with Skyways are also relevant I believe:

Me

Just to cover all avenues

When you took the 2007 Loan Repayments Cover:

Did you ask for it?
Were you told you could not have the loan without it?

Skyways

Hi There, No,to both questions. I wear 2 hearing aids and mostly have my wife at all apointments and interviews just to make sure of what is being said, she says insurance was just added on.
At the January 2007 docs aptt my wife was not with me,if it was anything at all about Parkinsons,she would definitely have been with me,She wasn't because I didn't know I had it till much lat
later in the year. I mostly write a note to doc before any apt about what I am coming to see them,and they are grateful for that as it gives them time to look at problem. Also if wife is not with
me I get doc to write things down, if the Jan 2007 aptt the word parkinsons was mentioned,I would most definitely have got it written down,or I just didn't hear him.

[Turboman]

Re: Medical Insurance Pre existing conditions

Finally finished--I hope I have done justice to what I have gleaned from Skyways--and hope constructive comments will ensue

Thanks

Turbs

[Eloise01]

Re: Medical Insurance Pre existing conditions

I think Turboman has done a great job of synthesising out a lot of information.

For what it is worth, to add to this debate, I have had a colleague who specialises in medico-legal claims to have a look at the paperwork and we have discussed the details at length.

We are both in agreement that if Skyways is able to maintain payments on the policy he should do so, for the reasons outlined above - it still covers any new conditions that may arise (or possibly have arisen since - we know nothing about Skyways current state of health other than in relation to the condition in question)

We also feel that misselling, at least in legal terms, is weak. We cannot comment on the issues about a possible route through the FOS as this is outside our field of practice. If their standard of proof is lower than that of a court, this may stand a chance. But in terms of a court, the fact that Skyways had the policy posted out to his own home, time to review it without any pressure, and a clear written option to not take out the policy, plus annual reminders from Halifax that he did not have to renew it and could shop around for other insurance as well - these undermine a claim of misselling in legal terms.

The problem that we face is, in fact, not with Skyways decisions per se - it is with the GP's evidence. The terms of the policy are quite clear in that if the condition pre-exists or could pre-exist the policy and medical investigations and/or appointments related to the condition had already occurred, then the condition pre-exists, even if the insured does not themselves know. So whether he heard the doctor or not, the GP is saying that the symptoms of the condition were the subject of a medical appointment before the policy was taken out. I have asked Turboman if it is possible for Skyways to obtain the notes of that particular appointment with the GP - such records exist and it would be useful to see what they say. But to be clear, all arguing aside about whether Skyways heard/knew/might have known that it was possible that he may be exhibiting symptoms of Parkinsons Disease, this is irrelevant based on the terms of the insurance - because the GP has positively said that Skyways exhibited symptoms a few weeks before the insurance was taken out, and this is what Halifax are basing their decision on. Those notes may, but it is only a may, provide a lever. To be honest, they could equally prove damning, depending on what is written there - but this seems a small risk because if this matter goes further it is quite certain that Halifax will require their disclosure anyway, and whilst this cannot be forced, Skyways may as well give up if he refuses permission for their disclosure. To our mind, however, knowing what help or damage those notes may be is key to determining whether there are good grounds to fight for a pay out rather than attempt misspelling.

I think that summarises our main thinking - there was lots talked about, but I am not sure how much more is necessary to put here - if I think of something else later I will add it.

Turboman - does that seems to summarise the key points I suggested to you from the discussion Paul and I had? Feel free to throw in anything else that you think I should have mentioned.

[des8]

Re: Medical Insurance Pre existing conditions

Nicely summarised Turboman.
May I suggest a closer look is taken at the document "Personal Loan Repayments Cover" on page 6 "Preexisting condition" the last paragraph and also the Doctors Statement no 59. This is possibly the way to a payout,
A gentle letter to halifax?

[Turboman]

Re: Medical Insurance Pre existing conditions

That is an excellent synopsis Eloise

I agree with everything you have said

I hope others will also post their opinions

In the meantime-I have asked Skyways if he can obtain the doc's notes

Thanks Elo

Turbs

I think Turboman has done a great job of synthesising out a lot of information.

For what it is worth, to add to this debate, I have had a colleague who specialises in medico-legal claims to have a look at the paperwork and we have discussed the details at length.

We are both in agreement that if Skyways is able to maintain payments on the policy he should do so, for the reasons outlined above - it still covers any new conditions that may arise (or possibly have arisen since - we know nothing about Skyways current state of health other than in relation to the condition in question)

We also feel that misselling, at least in legal terms, is weak. We cannot comment on the issues about a possible route through the FOS as this is outside our field of practice. If their standard of proof is lower than that of a court, this may stand a chance. But in terms of a court, the fact that Skyways had the policy posted out to his own home, time to review it without any pressure, and a clear written option to not take out the policy, plus annual reminders from Halifax that he did not have to renew it and could shop around for other insurance as well - these undermine a claim of misselling in legal terms.

The problem that we face is, in fact, not with Skyways decisions per se - it is with the GP's evidence. The terms of the policy are quite clear in that if the condition pre-exists or could pre-exist the policy and medical investigations and/or appointments related to the condition had already occurred, then the condition pre-exists, even if the insured does not themselves know. So whether he heard the doctor or not, the GP is saying that the symptoms of the condition were the subject of a medical appointment before the policy was taken out. I have asked Turboman if it is possible for Skyways to obtain the notes of that particular appointment with the GP - such records exist and it would be useful to see what they say. But to be clear, all arguing aside about whether Skyways heard/knew/might have known that it was possible that he may be exhibiting symptoms of Parkinsons Disease, this is irrelevant based on the terms of the insurance - because the GP has positively said that Skyways exhibited symptoms a few weeks before the insurance was taken out, and this is what Halifax are basing their decision on. Those notes may, but it is only a may, provide a lever. To be honest, they could equally prove damning, depending on what is written there - but this seems a small risk because if this matter goes further it is quite certain that Halifax will require their disclosure anyway, and whilst this cannot be forced, Skyways may as well give up if he refuses permission for their disclosure. To our mind, however, knowing what help or damage those notes may be is key to determining whether there are good grounds to fight for a pay out rather than attempt misspelling.

I think that summarises our main thinking - there was lots talked about, but I am not sure how much more is necessary to put here - if I think of something else later I will add it.

Turboman - does that seems to summarise the key points I suggested to you from the discussion Paul and I had? Feel free to throw in anything else that you think I should have mentioned.

[Inca]

Re: Medical Insurance Pre existing conditions

Wow.......it even makes sense to me now,,Excellent work Turbs and Eloise,,really good .x
I absolutely concur that the key to a lot of this MAY well lie in the GP's notes of 2007.

[Turboman]

Re: Medical Insurance Pre existing conditions

Aha-Des8--Hawkeye like me-lol
I spotted that too and asked Elo off thread about it

She concluded that the answer must be wrong and truth would come out later

For instance--Skyways had several recent medicals by Duradiamond requested by his employers and the last one concluded he was unfit for work -- several months before he left employment.

Turbs

Nicely summarised Turboman.
May I suggest a closer look is taken at the document "Personal Loan Repayments Cover" on page 6 "Preexisting condition" the last paragraph and also the Doctors Statement no 59. This is possibly the way to a payout,
A gentle letter to halifax?

[Turboman]

Re: Medical Insurance Pre existing conditions

Breaking news

Just received from Skyways

Hi Turbs,Got a letter from Doc, my own doc retired and new doc whom I have never met had sent Halifax notes.Went yesterday to see head Doc .He had a good look at files,and this is his report,which I have always stated.

Here's the content of the letter

8'" JULY, 2013

SAMANTHA DUNNE,
CLAIMS MANAGEMENT DEPARTMENT,
T.M.P.P. ADMINISTRATION UNIT,
PO BOX 534,
UXBRIDGE,
UBS IWF

Dear Ms Dunne,

Re: Skyways @ ....
CLAIM NUMBER ...
PLAN NUMBER ....

I as the above patient's General Practitioner can confirm that the above stated
registered patient attended his doctor at that time, Dr ...... on 11th
January 2007 with symptoms that were diagnosed as an intention tremor. He
was given treatment for that at the time, which was initially beneficial. I
understand that he took a loan out during the month of February that year.

Medical records clearly indicate that the label and firm diagnosis of Parkinson's
disease did not occur until he saw the Neurologist which was some considerable
time later. He was subsequently seen by a Neurologist on lOth September 2007
when a probable diagnosis of Parkinson's disease was made.

The patient,therefore, had insight and awareness of his ongoing medical condition from
September 2007 and therefore at the time of initiating the loan, was not aware
of any excluding or existing condition to prevent any policy from being taken.

I hope this clarifies matters and is useful in fairly attending to the above named
patients' claim under the agreed policy.


Yours sincerely,


DR ......

[Turboman]

Re: Medical Insurance Pre existing conditions

from Eloise01

Well that should make an enormous difference - what a shame the GP was much less clear in their earlier comments. I'll ask Paul to have a look, but I think this should clarify. It was unhelpful to suggst that the treatment started in January when they are now saying that they did not appear to be treating it as possible Parkinsons. Lets see what the insurers say now.

Paul says this is a definite help and he thinks that Halifax should, at the very least, seriously investigate the medical background; but he adds that he thinks this would probably sway them. In his view the only thing standing in the way was the GP's earlier statement, and without any evidence now to say that Skyways could reasonably have known, he thinks they would have a weak argument.

[charitynjw]

Re: Medical Insurance Pre existing conditions

Isn't there a continuous duty to disclose throughout the life of the policy?

[Turboman]

Re: Medical Insurance Pre existing conditions

Couldn't spot anything in the paperwork Chaz

Isn't there a continuous duty to disclose throughout the life of the policy?

[charitynjw]

Re: Medical Insurance Pre existing conditions

http://blog.ashburnham-insurance.co....-act-1906.html

Marine Insurance Act 1906



The Marine Insurance Act 1906 may be over 100 years old, but a very important part of this act is still used today in almost every insurance policy sold in the UK. This part is to do with the duty of disclosure on insurance policies.

Insurance is sold as "uberrimę fidei" which means it is based on the utmost good faith of both parties. On an insurance policy, the insured is expected to provide any material facts which is information that may be deemed relevant to the risk that is being insured. If you do not disclose all material facts then the insurer is within their rights to reject your claim even if they did not ask you the specific question in the insurance proposal. It is this act that probably gives the insurance industry their bad image of "getting out of anything" when it comes to claims.

A recent movement has been made to abolish this act which would mean that you would only need to tell the insurer what they ask you. This means that every insurance claim would have to be paid out as long as it is part of what is covered in the insurance policy and you have told the truth in the questions asked at the time of proposal. With the "get out clause" not existing, it may give the insurance industry a better name along with policyholders having a more secure policy.

The only downside is that with the insurer having to pay out more claims, they will inevitably have to pass these costs on to the consumers which means an increase in insurance premiums for us all. The change is currently only at the draft stage but it is likely it will go to parliament early next year and if passed it will effect almost every insurance policy sold here in the UK.

The contract is a rolling monthly policy, governed by UK law - would that make it an 'implied' condition in the contract?

(Sorry, just thinking out loud)