Claim Support from Vita

I have been helping one of our clients, a 37yr old single mum of two children, who was diagnosed with MS earlier this year. This has significantly impaired her health, and limited her ability to work. With limited savings and an uncertain outlook on her prospects of earning an income in future, it’s been quite a distressing situation for her.

Following submission of the claim, the insurer requested the usual GP records to assess which then subsequently led to the claim being declined due to non-disclosure by the client.

She was naturally distraught at this news, and couldn’t fathom why the insurer would reach this outcome as, in her opinion, she had told the truth at point of application.

The insurers take was that she neglected to inform the insurer of an MRI scan she had undergone a number of years ago (prior to her application with the insurer). Had they known this, and explored it further, it’s likely they would have declined her for cover in the first place.

They then went on to cancel the clients policy, and refund all premiums back to her (some ￡1,100). However, this then left the client in a situation that not only had her claim been declined, but she was now left uninsured!

Having been involved in the claim throughout, I decided to challenge the outcome, and with the client’s help we appealed their decision. Such is the nature of MS, it can cause memory loss – unbeknown to the client, it was the early stages of the MS that had led her to omit certain parts of her medical history from the original application as she wasn’t even aware she had had an MRI scan!

Upon appeal, the insurer wrote back out to the GP and obtained the commentary notes from every appointment that the client had ever had in relation to the MS symptoms. Within these notes, it mentions about her failing memory which supported her claims about not being aware of the investigations she had undergone and therefore, omitted from the original application.

After review of the medical information, I had the pleasure of calling the client and confirming that the claim had now been approved, and she would receive ￡84,000 into her bank account later this week.

You could feel the relief pour out of her when she broke down in tears, knowing how much of a difference this money will make to her family.

Credit to the insurer for overturning their original decision and looking for ways to try and pay the claim. Further evidence that insurers DO pay claims and payout billions of pounds as a result.

As we always say, never underestimate the work that you put in when arranging these policies, particularly living benefits such as Critical Illness cover & Income Protection.