Cancer excluded from critical illness insurance
In order to see this content you need to have both Javascript enabled and Flash installed. Visit BBC Webwise for full instructions
Taking out critical illness insurance might not be the most pleasing thing to go shopping for, but at least it's practical - especially if your mortgage or business depends on you being fit enough to work.
The premise is that you'll receive a pay out from your insurer, depending on how much you pay them, for a diagnosis of a critical illnesses within seven core areas; heart attack, kidney failure, major organ transplants, multiple sclerosis, stroke - and cancer.
So imagine how you'd feel if you did get cancer, but your insurer said it didn't count?
Watchdog has heard from several women this has happened to. In addition to being told they've got cancer, they also find out they're not going to receive any of the financial support they thought they'd paid for.
That's because they've been diagnosed with an early form of breast cancer called Ductal Carcinoma In Situ (DCIS). This is when a non-malignant tumour has been found, which has the potential to become malignant and spread, but because it's caught early is still contained.
Claire Carlson took two critical illness policies out with Norwich Union in 2001, costing £180 a month, because the bank wanted to make sure she'd be able to pay off her mortgages if she became too ill to work.
She was diagnosed with DCIS in March 2006, and it was explained to her that her form of cancer, while still in the 'in situ' phase, was also high-grade and therefore likely to become invasive. If this was allowed to happen she would stand a low chance of survival.
She was given immediate surgery to remove the lump, followed by radiotherapy treatment to reduce the chance of the cancer spreading.
An important factor in ensuring against this was to rest and recuperate. Fortunately Claire had taken out a critical illness policy to protect her from having to work.
Or so she thought.
Claire's claim was rejected because the type of cancer she had was excluded from her policy. Norwich Union told her that the medical information for her illness did not support a valid claim.
She told Watchdog: "When I read the policy, not knowing very much about cancer, I thought of it as one disease - I didn't know it comes in different forms - and I didn't know what in-situ meant. It was explained to me that it was a type of cancer that hasn't progressed to the type that could kill me - yet - and they don't cover you for this."
Claire took her case to the Financial Services Ombudsman, but told her they felt that the documentation was clear, and therefore were unable to uphold her complaint against Norwich Union.
Impossible position
The women that get DCIS are put in an impossible position - they need to have the necessary treatment to remove it before it invades, but in doing so won't receive the money they need, because their critical illness policy only covers them if it spreads.
That means if the cancer hadn't been detected, and had spread, she could have received a pay out.
Instead, Claire was forced back to work soon after her first diagnosis - and unfortunately was diagnosed with DCIS again in December 2007.
She said: "When I was told I had in-situ again I thought to myself, "I can't afford to have this - what's my family going to do"? I felt desperate - I was told I needed months off work. You even end up thinking if it had invaded, at least I wouldn't be a financial burden."
Because it had returned, they took no chances and removed the breast completely. However, complications with her skin healing following the mastectomy led Claire to need a further eight operations, leaving her physically unable to work.
"I feel that I've never fully gained my strength and can only do a fraction of what I could before I had my mastectomy. It's a disabling amputation - one that leaves you totally incapacitated - but I'm never going to get any money."
The fact is, it's standard across the industry to exclude carcinomas in-situ - cancers that haven't yet invaded surrounding tissue. Out of around 60 providers, offering a range of about 200 different versions of cover, there are only the following providers with products that pay out to policyholders undergoing mastectomies due to DCIS:
- Skandia's Skandia Protect product pays up to £10,000.
- Fortis Life's YourLife Plan pays up to £25,000.
- PruProtect pays 10 per cent of sa (sum assured - the amount the premiums are set to cover).
- AXA's Protection Account pays up to £15,000 or 20 per cent of sa.
- Unum's Elixia123 pays up to £25,000.
Insurers maintain they're only able to offer cover for the conditions which are generally considered to be immediately life threatening - and because screenings for breast cancer find cancers before they reach a life-threatening stage, they say this means they don't count as a critical illness.
Norwich Union gave the following response to Watchdog:
"Cancer in situ is specifically excluded from both Norwich Union's critical illness cover, as well as those of many other companies, because there's a good possibility that cancer at this early stage will respond to treatment. All customers are given a "key facts" document which lists the high level conditions that are covered by our policy, but adds that not all types of these conditions are covered. This document also tells customers where to find full descriptions of the conditions covered.
We're committed to ensuring that our customers understand what they're buying and we feel it's up to the whole industry, including insurance companies and advisers, to help customers understand their cover."
Unjust
It all seems very unjust to Claire: "One type of insurance is telling me I don't have a critical illness but when I want to take out holiday insurance they won't cover me because my condition is considered critical. Is it not critical that you have a breast removed? I'll die if I don't. That's pretty critical in my book."
Have you been affected by critical illness and had a similar experience with insurance?
© MMIX~RS~q~RS~~RS~z~RS~10~RS~)
Comments
Sign in or register to comment.
How can this poor woman lose part of her body to a potentially fatal ilness and not be Critically ill. I personally would like to see some strong action on this.
Complain about this comment
This situation and specifically the case of Clare Carlson must be brought to the wider public arena and be televised on watchdog.Clare carlson has had two bouts of cancer resulting in a mastectomy resulting in eight further operations.Norwich Union state in thier response that cancer which does not invade is not covered due to the fact that in most cases it will respond to treatment.But clare was buying critical illness cover how can Norwich Union argue this away? they can hardly argue that Clare was not critically ill.I urge every body who has bought this kind of cover to check it thoroughly and if you are considering buying a policy ask a medical professional to check it for you as it occurs to me this maybe the only hope of understanding the true benefits or in Clares case the lack of them.
Complain about this comment
This is dramatic story.. it is obvious that when Clare lose her breast there's not a respond to treatment, and I believe that this is not a first case. So the insurance companies will be waiting for more such cases to change the policy, how many women need to lose their breasts or other parts of the body in order to convince them that the insurance shut cover any of those illness.
Complain about this comment
This is an outrage and seems that the large insurance companies do not "care" about their customers but only want the money. Something needs to be done about this.
Complain about this comment
All insurance contracts, by law, are written "uberrimae fidelis" - "in the utmost good faith". The insurance company are acting in bad faith if they will not cover this sort of eventuality which is exactly the sort of risk the policy was taken out for
Complain about this comment
Do you realise that most heart conditions are clasified by the treatment.
To claim you need to have surgery that nvolved dividing the breastbone. Many serious conditions now dont need this type of treatment and are now no longer covered by your insurer.
Complain about this comment
This is the second woman in less than a month (the other was on the One Show recently) who did not have invasive cancer, yet who has fared far worse not having cancer than if she had had cancer. I think it is about time the medical profession and those in charge of the screening programme stopped lying to women about the so-called benefits of screening and ackowledged that it can lead to serious harm.
Complain about this comment
My partner was diagnosed as having dilated cardio myopathy last year. He spent 7 weeks in hospital and suffered 2 strokes and severe heart failure at 32 years old he no longer able to work. He has to go to papworth hospital in cambridge every 6 months to undergo assessments for a heart transplant.
He took out a life cover. critical illness cover with [company removed] which he paid £100 a month for. whilst he was in hospital i contacted [company removed] to notify them how ill he was and asked how we could claim to be told they do not cover this.
They only covered heart attacks of a specidied severity even though he is left with all of the after effects of a severe heart attack
It is absolutely disgusting as now our house is going to be reposessed as we cannot afford payments on it due to him unable to work anymore.
Complain about this comment
You take out a policy. It says what you are covered for and what you aren't covered for. Just because you "thought" you would be covered doesn't mean that you are. The polcy never purported to cover this kind of condition, so it isn't an "outrage". Making an assumption doesn't make it a fact.
Complain about this comment
Same thing happened with my mother who was told she 'had the wrong type of cancer'!!!
Complain about this comment
My mother has also had a similar situation when trying to claim her critical illness insurance. She was diagnosed as having type 3 agressive cancer which had spread and she had to undergo cheamo and further treatments.
She has been in and out of hospital ever since. It is such a stressful issue for my mother.
I am trying to assist her and have forwarded a complaint to the ombudsman but its really a case of fingers crossed.
I cant believe big companies can be allowed to act like this.
Complain about this comment
Dear Watchdog. Please advise your viewers that this "policy" doesn't just concern cancer patients. Our daughter had major heart surgery a few years ago. Aortic root replacement & aortic valve replacement. She was diagnosed with "Marfan Syndrome" as well. Because she didn't have " a heart attack" the critical illness insurance would not pay out. It all depends on the same old same old - the small print. when you've been through such trauma the last thing you need is someone with no experience telling you that your illness is not critical enough!!!
Complain about this comment
my partner passed away with cervical cancer 7 months ago, i have been in contact with the nationwide regarding the payment of my mortage and they say we dont have cover on our mortage,i am fed up to the back teeth with these fat cat bankers taking our money and giving nothing back. how many banks or building societys give out mortages without having some sort of cover on them.
Complain about this comment
Hi I had streptococcal a which went to necrotizing fasciitis a muscle eating bacteria. It ate my right leg and part of my stomach and thigh I cant claim anything. Went from healthy 40 yr old hairdresser mum of 4 to being given 1% chance of survival, no leg, hip or stomach not even entitled to sick pay. If I had died my husband and children would be able to claim.
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
After reading the above comments I feel I should step in. This is a terrible case and I feel sorry for this poor women who has had to go through this disease. However it is still a fact that the cover claire took out did not cover this particular illness at this stage. I don't want to be seen to be sticking up for this company as I feel that there are a lot of problems in this sector for starters to be called a critical illness cover, a policy must cover only 7 critical illnesses. My advice to anyone who is looking at applying for a critical illness policy is to read there policy documents fully and ask an adviser to explain everything in full so that you are aware of the exact condition needed to make a claim, this cover is so important and can help so many people to make this time much easier, it is a shame that norwich union could not offer claire something following the problems she has had.
Complain about this comment
It's easy to blame the insurer at the point of claim if they don't pay out, but often the blame can equally lie with the person who sold the policy in the first place for not fully explaining what's covered by it and what it's intended to do. In Claire's case, an Income Protection product would have paid out a monthly benefit if she was unable to work due to ill health, whereas Critical Illness is intended for people with severe, life-threatening illnesses which have long-term consequences. Fingers crossed, Claire will recover fully from her condition and be able to return to work in the future - someone with more advanced cancer may well not be so lucky.
Complain about this comment
I was diagnosed with secondary breast cancer in april last year, this means that i am now interminal, but as i am at present stable. [Insurer removed] will not pay out on my life policy. They say that they will only pay out if i have less than a year to live. I can not see why, i am going to die sooner rather than later, and the policy would give me the opportunity to leave work and travel/spoil my sons giving them something to remember me by. i have held this policy for over 8 years.
Complain about this comment
I was diagnosed with DCSI Breast Cancer last August. I had a mastectomy in September and I am still receiving follow up treatment. I have a policiy with [company removed]. I have been paying aprox £35 per month for Critical Illness since 2001.
I thought I was eligable for £20,000 but on inspecting the policy the criteria is that DCSI Breat Cancer is not valid for payment as it is non invasive.
How invasive does Cancer have to be.I have been through hell and back with my Cancer.
I cannot beleve these Insurance Companies.
Do they know what it feels like to have your breast removed.
Do they know what it feels like to think you may never see your grandchildren grow up?
Do they know how it feels for your family to go through this?
On analysis my cancer was actually diagnosed as some cells being invasive.
I am still waiting for an answer from my Insurance Company.
I am moving on.
I am working again after 2 months and on May 16th I am walking 26 miles on the Moon Walk in aid of Breast Cancer.
Your programe is brilliant.
I hope that Watch Dog raised this issue.
Thank you
Chrissie
Complain about this comment
my parnter last year got thoriod cancer and had to have half removed and now on tablets for the rest of her life. we find out in july if she still have cancer or not. Found out saturday that we can claim on this will let you all know how we get on.
ps since this happened she has never been right always unwell and of work
Complain about this comment
Why don't you report on the high percentage of claims that are successful for critical illness? You are guilty of scaring off people who would otherwise provide for themselves and their families should they suffer a critical illness. If this lady was poorly advised she should contact the ombudsman and raise a complaint in the proper fashion for compensation. Come on BBC whre is your unbiased journalism?
Complain about this comment
I don't wish to sound patronising, but the report clearly pointed out the terms and conditions of the policy clearly stated this condition would not be covered. What's more, the policy documentation does also. I work as an insurance salesman and deal with these kind of cases all the time. Client's take out the cheaper alternatives, don't read the small print, and then soon complain when they don't get what they want. Get good advice and read the terms in advance.
Complain about this comment
Having worked in both the mortgage and insurance industry, I have come up against the issue of these policies paying out. Having recently worked for the pru it was positioned that some policies are bottom end are some are higher end. It is so important to read the supporting documentation and the cheapest is not always the best as with everything in life, some of key selling points were those things not covered by the cheaper policies. However in the current climate cheaper is more popular. caveat emptor (let the buyer beware)
Complain about this comment
Sadly these type of exclusions are all too common amongst some critical illness (CI) plans available over the course of the last few years. Many older plans, such as [plan removed] (whole of life CI) and older style [company removed] provide cover against things that are no longer available today, including prostate cancer, "silent" heart attack and "low grade" cancers. The Association of Birtish Insurers (ABI) lay down a series of definitions that must be included within CI policies but some providers have always offered "ABI - plus" definitions so although you may pay more in premiums you get a better and more comprehensive level of cover. The moral of this story is that if you have an older style of plan you are more likely to have a more comprehensive level of cover - so whatever you do don't be tempted to lapse this type of policy in favour of a modern plan that won't give you so much cover. As an IFA I always make sure that potential clients are aware of the limitations of today's policies but I have personal experience of how valuable these plans can still be so, provided you're aware as to what's covered and what's not, they really can make a difference. As always the media pick on the claims that don't get paid, which is a fraction of those that are successful. If in doubt don't buy a plan until you're sure what it covers - and never without advice, it's nowhere near as simple as life insurance.
Complain about this comment
I sympathise, how can these companies keept taking money from people for years and when it is most needed you have to fight for what you're entitled to. I am also having trouble getting a critical illness payout. I have been diagnosed with an incurable respiratory disease and have not been able to work for 14 months now, my insurance company have refused to pay out on the grounds that my illness is not covered in their list of illnesses, but as my disease is extremely rare, it doesn't surprise me. I agree that if you have a critical illness and are unable to work due to the illness then you should be covered. I have put my case to the FSO, which has been with them for over a year now, and I'm still waiting to hear if a payout will be made.
Complain about this comment
I sympathise greatly as myself and my partner have recently suffered the same problem. My partner was diagnosed with a brain aneurism shortly before Christmas and his critical illness cover on a [company removed] loan would not pay out as they classified it as a "pre existing condition" meaning that they believed he must have had this problem for a long time and had remained undiagnosed!
He underwent surgery in January and luckily is now on the road to recovery but was unable to claim for loss of earnings etc etc. This resulted in a huge decrease in money coming in and as a result we have had to move in with my parents to recover financially. Please be warned that these insurances are often useless and are not worth the paper that they are written on!
Complain about this comment
It seems to be a common thread with this type of claim. I received a letter last week to say that my critical insurance is not going to pay out for a bowel cancer claim having received chemo and radio therapy and am going in to hospital next week to have part of my bowel removed to remove the remaining part of the tumor. I had a letter from the insurance company saying that they did not consider that it was cancer and therefore would not be paying out on this claim. It appears that these companies are happy to take your premium each month but do not want to pay out when you put a claim in. I now consider critical illness insurance to be a waste of money.
I know how this poor lady feels and she has my sympathy.
Complain about this comment
I think this is discusting this has defo prompted me to check my critical illness policy.Critical Illness policy's should pay out upon diagnosise of any form of cancer regardless of its status as this shouldn't be left till you are diagnoised with cancer or any form/status or a critical illness before you find out all the money you have been paying over the years would have been better off being burnt as your not covered and now face not only a very distubing time medically but finacially to.Critical Illness is taken on a what incase it happens senerio think of all those people in the world that have payed and never claimed and also those who also pay and to never get a pay out due to this clause all levels of critical illness cover is intended to help you though loss of work and ease the finacial burden this is a terrible.Mt heart goes out to you i think your very brave and your a credit to us as a women in the world. x
Complain about this comment
Time after time I have been asked to take out these sort of policies and I don't, because companies like Norwich union try anything to get out of paying up. This can also be the case when you have life insurance. What exactly does Claire need to prove to be able to claim? My advise is NEVER take out a critical illness policy. This can also be the case when you have life insurance. What exactly does Claire need to prove to be able to claim? My advise is NEVER take out a critical illness policy.
Complain about this comment
Its a shame Claire has had all this trouble with wound healing, I sympathise as a fellow breast cancer sufferer. My DCIS was removed six years ago and hidden inside was a dangerous grade three tumour. I was told that the future was uncertain, a possibility of secondaries coming later could not be ruled out. At least Claire you are not living with this fear. My breast cancer surgeon says that DCIS is not a true cancer, it is pre cancer, and secondaries do not appear years later with DCIS. It is 100% curable and I can see why it is not classed as a critical illness. Despite the tragic loss of a breast, sufferers can look forward to the future with confidence. As can women who have operations for pre cancerous lesions of the cervix.
It is very unlucky to have complications after surgery that stop you working, but not life threatening I wouldn`t have thought.
I was very hard up myself when cancer came and ensured I was a housewife going to lots of hospital appointments. I think McMillans help people to afford travelling costs etc. It is a pain, especially when you are young.
From Dancingwhiterat.
Complain about this comment
I was diagnosed with a Brain Tumour June 2009, being 36 and having a young family, I was glad to have a critical illness in place with a company linked with my life insurance/mortgage. The tumour was extensive and I had to go through a 12 hr operation involving a neuro-surgeon and a ENT surgeon due to the fact the tumour extended from my skull base eroded through my cheek and had spread down the side of my face. It took over 3 months to identify the successfully excised tumor and was found to be a rare Chondroblastoma, luckily a bengin form of aneurysmal bone cyst/giant cell tumor. I went through the process of claiming on my critical illness policy, but the claim was rejected for not meeting the criteria :- "Benign Brain Tumour - A non-maligmant tumour in the brain resulting in permanent deficit to the neurological system". I have since seen my consultant, and explained the situation as I have permanent paralysis of the right hand side of my face from chin to below the eye and also a 50 % loss of hearing of my right ear. I have been able to re-submit the claim on this evidence, but don't hold much hope of the insurance compay paying out. I agree with Claire, just how critical do you have to be before a settlement is agreed. There is a chance of the tumour returning and I am obviuosly pleased that the operation was a success and any further treatment wasn't required, but what about the future. I feel strongly enough to cancel my policy and told that was my perogative.. Critical Illness cover needs to be looked into or it's not worth the paper it's written on.
Complain about this comment
Fortunately this sort of story is rare, but highlights the main problem with this type of policy. What exactly constitutes a critical illness? I've been a financial adviser for 10 years and still don't understand why people don't take advice when applying for this type of insurance. The only time anyone ever reads the Terms & Conditions is when they try to make a claim. At which point it's too late. Critical illness is an incredibly difficult policy for most people to understand as it involves lots of medical terminology. The growing trend in the UK is for people to use price comparison sites to arrange insurance, which don't give any advice at all. I keep trying to tell people who ask me for advice that a cheap premium invariably means a policy with a lot of exclusions, but most people don't hear the message and take the low cost option. Also don't think that just because the insurer is a household name, that the policy will be the best. Remember these are the companies that spend millions on advertising, and have lots of overheads to pay for. The simple message is please, please take advice first!
Complain about this comment
My 29 y.o. daughter has just had emergency surgery for removal of kidney cancer which was accidently discovered during a scan for gallstones. She has paid for critical illness cover since she was 19 y.o. so I hope her insurance pays out. Once more the insurance companies are trying to pull a fast one. What Norwich Union are doing surely is amoral and I for one am advising family members to check carefully their policies. This is a truly despicable act on their part toward a young lady who trusted them enough to take out a critical illness policy.
Complain about this comment
I have failed back surgery & when I changed mortage companies they pushed the critical illness. I cant work but I initially took out the cover, I actually wrote to the insurers & asked for a list of illnesses covered because they were saying my back would not be covered, my argument was, if I was diagnosed with bone cancer, that originated in my back, would I be covered? I was informed they couldn't send me a list as it would be too long & they wouldn't answer my hyperthetical question. I therefore cancelled the cover there & then.
You should not be put in the position of only having some facts on something as important as your health & possibly your home.
Complain about this comment
Pity you didn't say during the show that it was, as ever, Norwich Union. True they're not alone in this particular get-out, but to knock on a claim for what is obviously a critical illness, leaving a lady in such distress, takes them to new depths.
Complain about this comment
How familiar this story is to me just last week I came out of Hospital following the removal of a large and very invasive Carcinoide tumour in the main bronchus.
The consultant had told me in February there was a real possibility I would lose my left lung.
As a builder I thought it was time to claim against my critical illness cover I have paid for over the last 10 years.
My insurance company told me as the tumour was in situ i was not covered. As to loosing my lung that I would not be covered for that either as it was not classed as a vital organ,only lungs were covered if you need a transplant.
I must say at what point do these things become critical. When you die?
When we were sold the cover and took the task option with it as i was a manual worker and my partner was a nurse both require physical strength. "Task" as we found out was the ability to carrying a 1kg load 5 meters not much good for a builder.
These companies should be ashamed by giving more worry at a very stressful time I bloody hate them!!
Complain about this comment
This lady's situation is awful and I fully sympathise with her, but on the other hand, what is covered HAS to be in black and white. If it was a policy that covered limitless Critical Illness' then the premium would be unaffordable for the majority of the population. The problem lies with the general public not being told about EXACTLY what the policy is at outset. An issue that lies with the person that sells the policy. As this women's issue is clearly the ammount of time off work she had to have and the disability she has been left with, perhaps an income protection protection policy would have been more suitable? Maybe this would be the case in many instances..?
Complain about this comment
I think this all comes down to mis-selling (again!). If I remember rightly, critical illness insurance was introduced to help those with a terminal illness by paying out before the (inevitable) death which would follow. In this context "critical" does not mean "serious", it means "terminal". If it was explained that really this is just life insurance with provision for early payment under certain circumstances where there is advance warning of death (as opposed to a sudden death or an accident)people wouldn't feel they had been short changed. There is permanent health insurance for loss of wages through illness but as far as I know the usual "accident" policies which pay out for loss of limbs, sign etc don't pay out for serious illness. It is down to the insurers to make the position much clearer before issuing policies
Complain about this comment
Clare's case is a mirror to my own story. I was sold female cancer cover over the phone by a company 6 years ago. I was told I would be covered for any cancer that effects women which would include breast cancer. Last year in June I was diagnosed with DCIS which was also high-grade and therefore likely to become invasive. After 2 MRI scans and 2 breast scans, 35 biopisy's taken I had no choice but to have a full mastectomy in Sept 2008. When I phoned to explain my situation to my insurance they told me like Clare I was not covered as my cancer was in situ. I thought cancer was cancer and never had even heard the words before in situ. I can't believe that insurance companies can get away with this. I ended up having 3 operations in Sepember due to complications with reconstruction and was back in hospital in January this year for another operation and with still more complications I will be going back in to hospital in the next couple of months. I will never again feel the way I did before I was diagnosed with cancer. I have had to return to work as my sick pay from my company has run out and with 2 children and a mortgage to pay the insurance money would have really helped. After all this is why I took out the insurance in the first place.
Complain about this comment
I had this type of cancer and the DCIS was widespread- I had a total mastectomy immeadiately and reconstruction from my latissumus dorsi muscle using a flap from my back. The insurance policy that I had was called the [company removed] policy and was specifically aimed at female cancer so you can imagine my shock when it didnt pay out. I was and still am self employed and have never fully recovered from the financial blow let alone the phsycological one.My policy was with AIG... the irony is that if you search hard enough the company offer two similar products and one of the policies does pay for this condition .... ask me for more details on here !
Complain about this comment
I'm not surprised at all by this story. My husband has recently been diagnosed with bowel cancer and despite having to have both radio and chemotherapy and with surgery to remove part of his bowel planned for early May, our Critical Illness Insurance is refusing to pay saying he has only got a "benign lesion"! They have based this decision on one tiny part of a report choosing to ignore 2 letters from our surgeon stating quite clearly it is malignant. This insurance is a total con. the minute you actually need it it lets you down. As the lady on the program said, you pay for "Critical Illness" NOT Terminal Illness.
Complain about this comment
Last year in june I was diagnosed with breast cancer and I had critical illness insurance from [company removed]. This company fortunately took the view that it was critical illness insurance and not terminal illness insurance and they paid out.I had the same treatment as Clare Carlson,mastectomy and radio therapy,the only difference is I am male.
Complain about this comment
I am in a similar situation with the Halifax at the moment as the lady featured on tonights programme with Breast Cancer.
Me and my wife have always purchased Payment Protection and Critical Illness cover with our mortgage as our home is our biggest asset and needs protecting! I was diognosed in Dec 2008 with a brain tumour so contacted [company removed] for the relavent paperwork as I knew I needed brain surgery and may be off work for many months, the papers were sent. In Jan 2009 The tumour was diognosed as Cancer so I have just done 7 weeks of Raidotherapy and have only been paid SSP for the last 2 months as I have only been in my job for 6 months! As you can imagine money is now becoming tight and 4 months on [they] are still messing about and havent paid a penny out fot PP cover or Critical illness cover! As the lady on tonights programme said "you cant get much more critical than cancer" You cant believe how ill I feel right now and I dont need this! I really feel for her and all the others as I know how it feels! If they keep doing this, no one will ever buy a policy again and they will lose a fortune by screwing sick people over!! The Halifax have not said NO but I feel thats whats coming so watch this space!!!!!!! GOOD LUCK to all the others in this situation and lets hit em hard and get the payments we deserve!!!!!!!!!!!!!
George
Complain about this comment
Please do not remove my last post as I have now just seen the rules and I put my email address at the bottom?
Please just remove the address?
Thanks and Sorry!
[Note from Watchdog: Thanks for your comment. You'll find it posted above. Best wishes, web team]
Complain about this comment
i feel very sorry for clare, as i to have been refused by my critical illness policy for cancer in situ, the stress and bitterness you feel after paying a policy for so many years and told your not covered. because we have proventative screening and are diagnosed with cancer in situ but still lose organs we pay the price. its not the policy its self thats wronge its the way it is sold to us, i to was told to take critical illness cover out when we got a mortgage. this is an area that needs urgent reveiwing as i am sure there are many in the same boat, as people are paying critical illness insurance and are having proventative cancer screening of which if they are unlucky to develope cancer and become unable to work or live a normal life they will most likley not be paid out. save your money, i would like to wish clare the best of luck for the future.
Complain about this comment
I have experienced exactly the same as Claire Carlson.
I took out a critical illness policy with the Prudential because I am self-employed, and I wanted peace of mind in case of illness.
In May last year I had a mastectomy and reconstruction. I was diagnosed as having Ductal Carcinoma in Situ. I didn't know what this meant. My surgeon explained that it was breast Cancer. I have asked around 200 people do they know what DCIS is? They've all said no, but everyone knows what breast Cancer is!
I feel cheated and conned and completely let down by the Prudential insurance, and to be told by a lady from the Prudential that what I'd got was not critical was completely hurtful and upsetting and a direct contradiction from what my surgeon was saying.
I was given 48 hours to decide whether to have Radiotherapy and surgery, or mastectomy.
My surgeon told me not to delay in my decision, time was critical!
The critical illness policy I had had for 5 years, at £50 per month. I have lost every penny on this, in other words the policy was not worth the paper it was written on.
I feel that these policies are extremely misleading in the way that they are worded.
Barbara Turner.
Complain about this comment
i was also diagnosed with dcis in 2003.i was advised to have a mastectomy due to family history.i had taken an insurance policy with wellwoman which covered just illnesses that affected women such as breast cancer,ovarian cancer etc but when i was dianosed i read in the small print that dcis was not covered.i rang the help line and they confirmed that dcis was not covered by the policy and that if i had gone on to be diagnosed with invasive brest cancer then i could then claim on my policy.i could have done with a pay out at the time really.i am still paying my monthly premium because if i dont make a claim,after 15 years then i atleast get my contribution refunded.
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
I can't help but feel that this is just another piece of sensationalist journalism.
The woman in the article has taken out insurance which would pay if she was diagnosed with a specific critical illness. Unfortunately it does not pay out for every medical condition.
It is not the case that the insurance company "does not care" or is trying to "argue it's way" out of the claim, as some of the comments here suggest. I'm sure that they would happily pay out if she was diagnosed with an illness that is covered by the insurance, but they can not be expected to pay out for illnesses that are not covered.
I suppose it's a bit like taking out motorcycle insurance and expecting it to pay out if you crash your car.
I think the problem here is that the woman in the article did not understand the insurance she had taken out. If she wanted insurance which would pay out if she was unable to work she should have considered Income Protection Insurance. Although this type of insurance would not pay out an immediate lump sum large enough to pay off your "mortgages", it would pay you a proportion of your income whilst you are unable to work due to illness.
Complain about this comment
I was diagnosed in Aug 07. I was told that I had breast cancer when I got my biopsy reports. I needed a total mastectomy(removal of breast)because I had over 6 cms of cancer cells in more than 2 places. After my mastectomy I was told all the cancer cells were "in situ" but high grade(the most dangerous)the cancer cells were 1mm from my chest wall and that they also found another cancer behind the nipple called Pagets disease. You've guessed it, my critical illness would not cover me. I was devastated, to have to tell your children and family that you have cancer and then find it is not serious enough to be considered critical is beyond belief.
Complain about this comment
This was my second time of having breast cancer I had my first breast remove ten years ago and this was instu. The second time it was not and I applied to my insurance company for a percentage of my insurance as I was on my own with a house and three children to support. They wrote to my doctor and said that if he could tell them that I would be dead within 12 months they would pay out the policy. Obviously he could not confirm this so that was that. I worked all the way through my Chemo because I had too. Luckily enough the Company I work for Just Taxis were very good and if I felt tired or sick they took me home. Why would I have a critical illness cover policy when really you have to be terminally ill to get a pay out.
Complain about this comment
I work in Financial Services and am a great believer in and advocate for Critical Illness cover. I fear that sensalationist journalism will deter other people from properly protecting themselves financially. It is a fact that most plans specifically exclude 'in situ' cancers and this is clearly stated in the policy information. Sadly the majority of customers do not read this, or choose to forget, when it is explained to them. Perhaps, in spite of it being clearly stated in the documentation, we need to re-iterate the message, but the sales process would become too cumbersome and most people would switch off. To provide cover for 'in situ' cancers would make these type of policies too expensive and even less acceptable to the general public. This is a most unfortunate case, but this lady does not appear to qualify for the claim to be paid. Surely she will qualify for state benefits though?
Complain about this comment
"Taking out critical illness insurance might not be the most pleasing thing to go shopping for, but at least it's practical - especially if your mortgage or business depends on you being fit enough to work"
If you want insurance against being unable to work, you want "Income Protection" insurance. As it suggests, it will pay out if you aren't fit enough to work. And it'll pay out every month until you can return to work.
Critical Illness is insurance against having a very severe illness NOT against being unable to work.
Complain about this comment
As an independent financial adviser (IFA) who specialises in protection I have great sympathy for Claire. It is an unfortunate truth that no two critical illness policies are the same and it is also true that no member of the public can reasonably be expected to undertand the subtle differences and make a valid choice. It is for this reason that consumers need to approach anh IFA so that an expert opinion can be provided.
Recent developments from leading insurers have included some cover for breast cancer and knowledgable IFAs are able to guide their clients towards the most suitable plan for their individual situation.
So far eleven of my clients have claimed on their critical illness plans and all have had cancer and all have been paid out. It would be a dreadful shame if Claire's sad story turned people away from taking sensible steps to protect them and their families.
Complain about this comment
Well clare here lies a tale, I know what your going through. I have had my insurance company refuse to pay for any of my treatment. I am a 48 year old English woman living in Cyprus only been here 18 months.
First they told me they would pay so I went ahead with the surgery only for them to back out of it, saying it was pre existing, meaning that I had this cancer for two months before I did anything about it.
As I am in the medical profession and do mamogrammes myself I find it hard to believe how anyone could use this excuse to get out of paying for breast cancer surgery.
I now have a bill for 12000 euros and rising, which I cant afford to pay, I have had to organise a payment plan with the surgeon and the private hospital.
Then there will be the cost of lawyers, as I believe they should have paid for this, so now I have to take them through the courts.
so yes clare I know how cruel insurance company's can be.
Complain about this comment
In 2007,I also was diagnosed with breast cancer and was told by doctors that due to high grade I would need a mastectomy.I was given no choice as I was told if left - threat to my life. NO WOMAN would have her breast removed if she did not believe the doctors advice that it is critical to health to have removed asap.
I had also responsibly taken out a critical illness policy with [insurer removed] to cover me in this situation.
I was also not covered as diagnosed as DCIS and my complaint, which I also took right up to the ombudsman, was not upheld.
It is only by complaining in LARGE NUMBERS that MAYBE something could be done to change this ANTI FEMALE ruling.
By having our breasts removed, we remove the insurers liability to pay out.
The diagnosis,I feel, could also be FLAWED as a sample is sent away from lump removed and lymph nodes but it is not 100% that NO cancer cell has spread !!! It is a percentage likelihood only !!!
I have received in the post this week a plan offered by [bank removed] which excludes payout on DCIS in all cancers EXCEPT breast cancer for which the £25000 payout would be made. I cannot take out as breast cancer already suffered but I do wonder WHY decision made to pay out for breast cancer DCIS ONLY.
I also am now refused travel insurance cover for breast cancer which I agree is a double standard for insurance companies. If they will not pay out because I had my breast removed thus removing all danger - why can I not get cover.
Watchdog -PLEASE run a campaign to highlight this unacceptable situation and see if NUMBERS will add strength to the issue.
I am currently awaiting results of a lump in same breast. What do I do if advised cancerous and mastectomy again??? Request regular monitoring of lymph glands to know when a single cell goes through to receive financial payout?? I have also struggled to work effectively since first diagnosis and feel TOTALLY LET DOWN by insurance company.
Complain about this comment
I have every sympathy for this lady, but all critical illness plans cleary state that if it is 'in situ' it will not be paid out. Rules are part of every day life and are there for a reason and in this case they do apply to Critical Illness Cover. Other comments above state it is a disgrace that the companies do not pay out following her breast being removed, it does not say in the report if she cancelled her plan following the first unsucessful claim, which I expect she did. I would guess if the plan was still valid it would have paid out at this stage. This report puts a very bad light on critical illness cover and is very unfair, why don't you document were many, many people have benefitted from having this particular plan as a balance. I feel only the bad stories are ever published which are the extreme minority.
Complain about this comment
I have known Claire for around 20 years she is one of my best friend. I have seen this vibrant lively young woman change because of a vile illness which has almost taken her life twice and disfigured her for the remainder of her life. Not only the trauma of being ill but the additional trauma of financial worries.
There have been occasions where I and other friends & family have begged her not to go back to work when she has had open wounds days after major surgery because she has been so worried about not being able to provide an income that supported her life. The only reason she did not go back was because she knew she was physically incapable of work. This did not stop her from sitting at home worrying about not working.
However the Insurance companies operating this policy that deem an in situ carcinoma ( believe me when I say I know what this is now) as not a critical illness are the same insurance companies that Claire will never get insurance from again because she has had a critical illness! This is double standards operating at the highest level.
Are women supposed to allow a cancer to invade before they seek treatment so they can be more sure of a pay out but less sure of survival or will the insurance companies see the error of their ways and redress this situation. Claire can't cancel the policy because she won't be covered for other eventualities & she won't get another policy because of her "critical illness"
My friend nearly died & the insurance company is dancing around the finite details of wording. SHE NEARLY DIED is that not critical enough for you?
Complain about this comment
My partner watched the programme last night with intent as she is in the same sort of position only just recently having been diagnosed with breast cancer and has undergone the mastectomy operation. We are now just started our claim through our Insurance company for the critical illness but we are now concerned after seeing this programme that as with most insurance companies they are quick to take your money but just as quick it would seem to worm out of the cover they say they were going to provide. Cancer is a critical illness and should Claire have waited for the tumour to have gone invasive then I am sure the Insurance Company would then have said she didn’t act quickly enough to resolve the problem and so get out of paying that way. We both feel that Norwich Union have treated Claire Carlson in a disgusting manner and I have also my own cover with them and in light of this will be in contacting them with the intention of pulling my monthly payments away from them if this is the way they intend to treat Claire. The product Claire was sold was not fit for purpose and as such she should be entitled to at least all of he monthly payments back. We will wait to see what the response is to our claim should you be interested I will let you know the outcome. I feel a united front needs to be formed to embarrass Norwich Union.
Complain about this comment
I was diagnosed with DCIS 4 years ago and had a 5 hour operation which involved partial masectomy and a rebuild from my back. I also has critical life insurance with [company removed] when I brought the policy I was assured it covered all cancers but when I claimed I was told that the policy didn't cover any cancers instu.
I am still having to see the specialist. The specialist told me if I didn't have such radical surgery I would not see my children grow up.
It is still very stressful for myself and my family as I am still seeing the specalist with the possibilies of further surgery.
Complain about this comment
How can this be right, critical illness cover for a critical illness how ill do you need to be. The system needs a complete overhaul.
Complain about this comment
I can truly sympathise with Claire and would like to make more people aware of this exclusion in these policies. This does not only affect women with this particular condition.
I was diagnosed with a tumour which was operated on and found to be a “cancer in situ”.
I was denied payment from a critical illness policy as this was specifically excluded from their criteria. I was told “Cancers in situ have a positive prognosis after treatment. This is why they’re not covered by critical illness insurance.”
Like Claire I took out this cover to cover critical illness and saw the headline coverage of “heart attack, stroke, cancer, etc” without understanding the detailed exclusions under cancer that have negated my claim. It is strange to think that you can suffer a heart attack and survive it in reasonable health and make a successful claim yet you can go through the trauma of being diagnosed with cancer, major surgery, a long recovery, and be told it doesn’t count as a critical illness.
I recently broke my collar bone and was being examined by the orthopaedic consultant. On looking at my scar he said “wow, that’s some scar, what was that for?” When I told him he said “well, every day’s a blessing for you then”. I’m not sure he would agree with the insurance companies definitions.
Complain about this comment
I took out a Critical illness policy with [company removed] in 2005, whilst in good health. The financial advisor who sold it to me described a situation very similar to the one I now find myself in. I had back surgery last year which has left me with loss of balance and drop foot plus ongoing back pain aggravated by the fact that I live up 3 flights of stairs with no lift, a point which the man from the co op described as a good reason for the insurance. I have lost much work throughout this last year and a half and am still struggling. They have refused to pay me. My sympathy goes out to Clare Carlson.
Complain about this comment
this is another way of an insurance company shirking their responsibilities to pay. surely the FSA who regulates them should insist clear concise literature is provided at point of sale rather than simply refer to full policy details which is often not readily available.this is the small print which should be LARGE PRINT then not many sales would be made on this basis. this cover is very expensive so whats the point in taking out such a policy-just to make insurance companies richer!. what medical expert can possibly diagnose, if in the future, what they have taken away does not reoccur in other bodily parts. cancer is cancer and your longevity is threatened invasive or not. insurance companies and the FSA need to address this underhandedness as peoples quality of life is at risk...
Complain about this comment
It's a real shame that, after plugging this story on watchdog last night, the BBC have chosen to take over 17 hours to review comments on the website.
There is a major lack of understanding of this type of policy, which the industry should be trying to address - and where the likes of watchdog and the BBC could provide valuable assistance.
Unfortunately, I suspect people aren't even going to bother checking back to see if their comments have been published.
[Note from Watchdog: Thank you for your comment. Comments to the Watchdog website are legally contentious and need to be carefully moderated. Due to this and the large volume of responses to the programme on Monday 27 April, we have been unable to publish comments immediately. Best wishes, web team]
Complain about this comment
When setting up a life and critical illness policy it explains exactly what you are covered for and leaves no element of doubt whatsoever. In this case she claims that the cover is claiming to be something that it is not, when she openly admits that she did not actually understand what the medical terms mean. It clearly states in the Key Facts Document of any of these policies that it covers cancer, and then explains which types of cancer are covered. Before she signed up to one of these policies she was provided with this document to look through and if she was unaware of what something means it was up to her to ask the adviser or a medical expert what it actually means rather than assume or expect to be covered. Of course critical illness policies do not pay out for all types of cancer or everyone who had a form of none threatening skin cancer removed would be claiming and the insurance companies would go bust. The companies are there for a reason and the cover they provide is very good and essential to people who really need it, but in this case she is simply trying to make a big fuss in order to get money which she is simply not entitled to. I hope Norwich Union stick to their guns and don’t pay out in this case because quite frankly its up to her to find out whether the cover is right for her and as she was clearly told before taking out the policy what was covered. She has no right to claim for something which they explain is not covered from the outset. I normally support watchdog but in this case I think it is ludicrous that you have even chosen to use Carole as a case study as she clearly has no legs to stand on. How can you expect something which you are clearly not entitled to?
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
In regards to comment 16 you are compltely incorrect. The ABI (Association of British Insurers) says that a critcal ilness policy has to cover 23 illnesses to a certain standard and its people like yourself making comments when they are actually unaware of the true facts who give the indusry bad name. People should realise that the indusry is much better now than it once was and claim payout percentages are much higher now than they have ever been due to increasing pressure from the FSA.
Complain about this comment
I have had cancer twice-who says it is not critical illness? Have they had cancer? This poor girl all that worry-the least they could do would be to refund her all those £180!!!!The best would be to pay her what I think they owe her!!
Complain about this comment
Just to let you know. As I type this, [company removed] are lauching amendments and enhancements to many of their products. One of these enhancements is increased payments on
Mastectomy for Carcinoma in Situ
Moved from Severity F to Severity D
whereby this has moved from Severity F (10% of sum assured - to D 25% of sum assured) as the company recognises the impact that this disease can have on the clients life.
Complain about this comment
I am sure that all of these poor people took out their insurance policies as a pre-requisite for a mortgage. I'm sure they did not think I will exclude this or that because there is no chance I'll be diagnosed with it, or that it will be cheaper if I exclude losing a lung or part of my heart or my breast.
I am sure they read the highlights of the policy, saw cancer saw heart attack and thought ok that seems fine. In the real world people don't take their policies to the doctors for an explanation, of what critical illnesses are covered and what aren't, and what their chances of getting those diseases are.
As the man commented you don't take out a bike policy and claim for your car, well you don't take out insurance on your car sir and exclude being hit by red cars which is what these critical illness policies do. No one is suggesting that these people don't now understand fully that their particular illness not just cancers are not covered, however it is the ambiguity on taking out the policy that critical illness cover does not mean you are covered for an illness that might kill you it means if you are lucky enough for your illness to be on a list of illnesses deemed critical by the insurance company, you are covered.
These people are seriously ill they have lost years of work through debilitating illness they are not trying it on they are trying to highlight that the insurance companies are covering you for some critical illnesses but not the one you are going to get!!!
Complain about this comment
Well done Watchdog! You've done for critical illness what Peston did for the Northern Rock. All that has been achieved here is to make ignorant people even more ignorant.
Complain about this comment
Clare has my sympathy but I am afraid that the story last night was not new to me...
In 2006 I was diagnosed with ovarian cancer and underwent two fairly intrusive surgical procedures including a total hysterectomy at 32. Having taken out a car loan with my bank I had also taken out some insurance and although they made my payments for me during the time I was off sick they would not pay off the £3,000 left on the loan. Initially I was furious and miffed that my cancerous growth (which was the size and shape of a rugby ball and weighed 2.5kgs wasn't the right type of cancer!) but then I decided that I could put my energies to better use and maybe battle the bank when I felt stronger...unfortunately in 2007 I was diagnosed with another primary cancer this time in my breast....well I had the last laugh because this time the bank paid off my loan, well the last three payments I had to make lol...
At times of stress people need support not further problems. When you are diagnosed with cancer, no matter how strong and determined you are it is the day to day things that sometimes the most difficult to deal with. A friend of mine stacked up loads of charges etc on not paying bills whilst she was undergoing treatment and she had the money in the bank! It was that sorting it all out, even actually opening the post to find who she needed to pay was too much to do on top of coping.
Complain about this comment
Re comment 58:
"Claire can't cancel the policy because she won't be covered for other eventualities & she won't get another policy because of her "critical illness""
So, despite her dissatisfaction with this type of insurance, Claire still feels that the cover is worth paying £180 each month for?
This just goes to highlight what an utter non-story this is.
I don't understand why this is being given prime airtime on BBC1.
Complain about this comment
Thank you for responding to my comment at 65.
Now that I have been able to read the comments on this, I think it’s clear that there remains a significant problem with the public perception critical illness. I don’t think it is an issue with the insurer per se – they have just designed a product, which sells. The problem is that the people who buy it don’t understand what they’ve bought until it’s too late.
Critical Illness insurance originated in South Africa, where the payment was meant to help pay for your expensive hospital treatment. This doesn’t work so well in the UK, we have the NHS so what is they payment for? It’s not the insurance to cover you if you can’t work, so why does anyone genuinely need a windfall payment? Unless they want to be able to pay for private medical cover when they are really ill (a catastrophe PMI if you like?).
Maybe the industry needs to sell different levels of critical illness, like with car insurance – ranging from a cheaper “only really severe stuff” through to an expensive “fully comp” which pays for any cancer/heart attack/etc.
I’d like to see watchdog address this properly, rather than the sensationalist 2 minute slot we saw which amounted to “evil insurer is mean to ill woman”. Get insurance representatives in to put their case forward, just generally start helping to educate people on this product rather than running stories saying “person misunderstood product” – genuinely try to improve that. The industry could do more, but many more people watch and trust watchdog.
Complain about this comment
Personally I think critical illness is a waste of money! Read the small print and when all comes to all you`ve have to be nearly dead or severly disabled to get it! I had a policy and I unfortunately got bacterial meningitis in January 2008! I lost all hearing in one ear and have been left with little hearing in the other! I have balance problems and am always so exhausted now! I had mislayed the `key features` booklet so went onto the website of my insurance company and found critical illness covered bacterial meningitis! I telephoned them and asked for a copy of the `key features` and they said they couldn`t give me one! They asked why I wanted a copy, I explained and they put me through to the claims dept! Not at any time did anyone there ask my name, policy number, nothing yet I was promptly told I was not covered! I rang later to request a claim form and they took my details yet was told I was not covered! I saught legal advice and was told that I could not be refused a claim form! Once again I rang was then told that back in 2000 when I took out my policy my cover did not then include bacterial meningitis! Yet my policy said that it may be subject to a review every 5 years! It had never been reviewed! So, basically, I could only claim if I could prove that I would never be able to work again! There was a list of 6 criterias....3 of these were, not being able to hold a pen/pencil, not being able to feed myself or not being able to dress/bath! So needless to say you have to be severly disabled. The whole idea for this cover is to support you or your family in a moment of need, I was off work for nearly 5 months, my husband lost a lot of work as he had to take time off to look after me and the children! So it not only left us emotionally drained but financially drained too!
Complain about this comment
I'm afraid I have to support the insurance companies here...
Ductal Carcinoma In-Situ is curable, therefore should not, quite rightly, be considered a critical illness.
If you left a simple bacterial skin infection without treatment, it would probably lead to septicaemia and eventual death. Should that therefore be considered a critical illness? Absolutely not.
I'm sorry for the lady with DCIS, who I hope makes a full recovery.
Complain about this comment
Not surprised. I applied for income protection and the premium was doubled because my mother has had breast cancer!
You want to see how people who've had depression are affected. My husband cant even get cover for any illness unless he pays a exorbinant amount. And thats despite having the illness over 10 years ago.
Complain about this comment
I would have hoped to see a little more balance to the way in which the storey was presented. In all cases like this the insurance co has their hands tied in terms of data protection and cannot talk about individual cases.
It is a shame that the lady was unable to claim under her policy. Its also good to see that more companies are looking to cover these pre malignant type of things. The fact of the matter is that she has not had an invasive cancer.
I do wish her well & hope that she is fully recovered.
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
I totally, totally sympathise with Mrs Carlson. I have the utmost respect for what she went through and I don’t begin to understand the pain she endured. If being struck down with this terrible disease wasn’t bad enough, the policy which she thought would pay out didn’t. However, this wasn’t the fault of the insurance company.
If you try and look at the bigger picture and take the “cancer” out of the equation. Mrs Carlson sought after a policy, and she even admitted that she didn’t know much about cancer. "When I read the policy, not knowing very much about cancer, I thought of it as one disease - I didn't know it comes in different forms - and I didn't know what in-situ meant".
Even though she didn’t know everything regarding the policy, she still signed and agreed to its terms and conditions.
It sounds exactly the same sort of situation everyone gets in when filling out official documents. Simply people don’t read things properly or don’t fully understand what they’re signing for and what they’re agreeing to.
I don’t believe the statement that these women are put in impossible situations. I know that I’m probably going to be hated for saying this but, maybe if people read the terms and conditions of the policies they intend to take out and if they need to query something, then do so, and come back and sign it when you are ready. And maybe people in these situations will get the polices that they actually wanted rather than the policies which they had thought they got.
People who intend to take out any form of life insurance or critical illness insurance should seek the advice and help of a doctor.
Get well soon Mrs Carlson
Complain about this comment
I was diagnosed with breast cancer in 2001 had the lump removed then chemotherapy and radiotherapy. I was amazed that this lady's insurance company would not pay up. It is time these companys were brought into line as any time I apply for holiday insurance and mention the word cancer up goes the insurance premium and am told they will not cover anything relating to cancer. it seems the insurance companys make up the rules regarding charging premiums or paying out claims.
Complain about this comment
I completely sympathise with this lady. I was diagnosed with breast cancer in Oct 08. I had in place critical illness insurance. My cancer was malignant and classed as invasive. I was well aware that during my insurers investigations they were trying to establish whether or not my cancer was insitu. I had no idea what insitu meant until investigations began. Unfortunately or fortunately whichever way you look at it my cancer was not insitu, it was invasive so my insurance company paid my morgage.
Whilst I agree that we are not all medics and or lawyers therefore do not always understand the medical and legal jargon within our polices it is up to us to clarify content, however it can be a minefield of confusion so it should also be the responsibility of the insurance company to clarify at 'point of sale' what terms like 'insitu' mean. Unfortunately if your policiy states 'insitu is not covered' then legally it is not covered.
Having said all this I cannot stress enougth that cancers (this should apply to all critical illnesses)that are and are not covered should be scrutinised and revised by the appropriate body - the reason being -
My treatment to date has consisted of surgery, chemotherapy and radiotherapy. I have as yet, touch wood, not had to have a mastectomy -
If insitu cancers require the same treament as and in some cases more radical treatment than invasive cancers, then WHY ARE INSITU CANCERS NOT COVERED?
I am unfortunately, not having as much luck with my medical insurance. If I do not receive a satisfactory response from my insurers I will be contacting watchdog.....watch this space....
I would like to add, covered or not, I wish all those diagnosed with a critical ilness a very speedy recovery.
Complain about this comment
I am an IFA who regularly recommend critical illness cover to my clients. I use software that asks a series of questions to determine what the client would like to include in the policy. Often the wish list excludes every provder, so we have to go through a process of removing the least desired options until we get some results. Then the premiums are more than the clien is willing to pay, more options removed until we get to a premium the client is content with. Sometimes even this is not enough so reducing the sum assured and or term is required. The upshot is that the more conditions that are covered at earlier stages the more the premiums have to be. This would drive more clients and potential claimants out of the market, less competitors in the market, higher prices etc etc. A balance has to be found, inevitably this will lead to some apparently harsh decisions.
It is impossible to feel anything but sympathy in cases like this. However, we should remember that many claims are paid for example I have recently received some statistics from one compay in the market [company removed] that claims £14m claims paid, 356 claims, largest amount £260,000, and average £77,000 paid since launch. It would be nice to get a balanced view by getting a report from a customer who has had their payout.
I this report doesn't deter potential applicants, rather that they ask questions about what is in the policy, if something is important then perhaps we shouldn't look for cheapest price but best value for money.
Complain about this comment
I am also an IFA and, whilst the specific circumstances described in this case are difficult for the individuals concerned to deal with, I would like to point out some positive outcomes from "Critical Illness Policy" claims.
In my experience of advising clients I have had three claiming on their policies
1) A 27yr old male school teacher who was diagnosed as suffering from a non hodgkins lymphoma (cancer). The insurance company paid out £90,000 on a policy which had only been in existance for 3 mths.
2) A 25yr old male surveyor who was diagnosed as suffering from Multiple Sclorosis. The insurance company paid out £85,000 on a policy which had been in existance for 11 mths.
3) A 35yr old male scaffolder who was diagnosed as suffering from a brain haemorrhage / stroke. The insurance company paid out £45,000 on a policy which had been in existance for approx 2yrs.
This type of insurance fails to pay claims for two reasons. The first is non disclosure where the client has not told the whole truth at the application stage and the other is that the specific criteria for definition of condition has not been met. (All companies spell out exactly what is covered in their documentation and there is always at least a 14 day cooling off period should the purchaser choose not to go ahead with the policy) As a previous message pointed out there is always a tension on price v quality (comprehensive cover) at the point of sale / purchase and compromises are usually made at this stage.
There are a number of different types of policy available to protect against various scenarios such as loss of income due to redundancy, loss of income due to sickness or accident, diagnosis of a "serious illness", diagnosis of a "critical illness", private medical insurance and death.
In summary it is important for the individual to understand exactly what they are insuring themselves against, that it satisfies their priorities and that it is affordable on-going. The ideal is to find best value as opposed to the lowest cost and the best way to achieve this is via advice from a reputable IFA.
Complain about this comment
I am insensed by some of the unsympathetic comments from people who do not understand what us DCIS ladies go through. I followed my Oncologists advise and now have a "marvellous new boob" - if I hadn't I may be dead! If I had not had the surgery and taken a "wait and see if it develops" approach, my payout would not have been received because I had not followed medical advise. I have contacted NU with regards to taking out a CI policy but told I cannot have one because I have had cancer. Funny though, when I asked them to pay out on my policy, I didn't have cancer!!!! I am attending a support group with girls who have had invasive but lymph node negative cancer and they get pay outs - be advised that some of these ladies get to keep their boobs and now have the same life expectancy as me....but they are mortgage free. Where is the fairness in that?
Complain about this comment
May I add to my above comment that I was 36 at diagnosis and that my cancer was found by mistake. I regularly self check but my boob just didn't feel right so went to see my GP - just following advice in the media and from the cancer charities. Had I waited until a lump was feelable, I may have caught the disease before it had spread via my lymph system but a payout would have been made without question as it would have been invasive into breast tissue.The reason behind my boob not feeling right was nothing to do with cancer. I penalised myself by taking care of my health!
Complain about this comment
My wife was diagonosed with a benign brain tumor and had neuro surgery and has been left with epilepsy and still has some of the tumor left in situ but our critical illness cover would not pay out as it was not considered a critical illness sometimes wonder if it is worth taking out any of these so called policies.
Complain about this comment
View these comments in RSS