Hi all, I have just had my critical illness claim rejected because my doctor, when filling out the form to the insurance company wrote that I had thrombocytosis as far back as 2002, I was 35 then. He also states (and starred and underlined it) that ET 'is not a cancer'. 2002 was around the time I took out my policy and I was not aware I had anything in 2002 or i would have definately put it in the form. I was told my platelets were high during my first pregnancy in 2006, was sent to see the consultant once then immediately dismissed saying I had nothing to worry about, so I didn't think about it until my diagnosis last year. I also went on to have another baby and nothing was mentioned about the thrombocytosis. I will appeal but if my records state what my doctor says I dont know how can I prove I didn't know about it?
I was really hoping to reduce my mortgage and debt burden with the policy so I could work less hours and help with my constant tiredness.
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malachy
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Poor you, sounds as though your doctor is being extremely harsh and doesn't really appreciate the symptoms of this horrid cancer.
If I were you I would seek the opinion of your consultant who will know far more than your GP about all this - he may be able to override your GP's letter?
obviously your Doctor needs to read up on ET and all other MPN's and hasn't kept up to date with new findings! My other half was diagnosed with ET only 3 months ago after he had a bone marrow biopsy and the hematologist told us it was a blood cancer, his platelets were at 1475. I have read a lot on here about insurance claims and the help as been amazing, The link that got posted on here a while ago doesn't seen to work now, for some reason it has been moved! Glad I saved a copy! I can email it to you if you like?
Your Doctor was wrong to say "ET is not a cancer" - What did your hematologist say about it? As they would have written to him/her also. I would contest it if I was you!
Sorry to hear about your claim. I would definitely appeal this.
My insurance companies (legal & general and Scottish provident) both wrote to my consultant when I made my claim. Remember these people are the experts in this field and not your GP. ET was reclassified as a cancer a number of years ago and I would get a copy of this statement from reflex4 as backup for your claim.
Sorry to hear you are having bother with your critical illness claim. Like the rest have said your haematologist should be answering the questions from the insurance company. We have got blood cancers and should be able to claim critical illness and free prescriptions, etc. I have PV and Legal and General paid out without any fuss. They wrote to my consultant. I would change my GP if I was you. Don't give in. It is hard enough having these conditions without other hassles in life. Best wishes Aime PS let me know how you get on.
Thank you all so much for your advice and support. I will contact my haematologist like you have advised and see what she can do to help. Reflex4 as far as I am aware my haematologist has not disputed anything? I also have a meeting with my doctor tomorrow and will take along the proof re our conditions to bring him up to date! Also, I will change doctors Aime after this. My biggest surprise in all this is that I have potentially had this condition for much longer than I was aware of. This is probably the case for many of us. Once again a big thank you to you all. Take care. Diana x
I have had successful claims for critical illness cover and although diagnosed only 18 months ago I have actually had high platelet levels for the last 10 years.
I think you have every right to go back to both your GP and your consultant and question them both. Makes you wonder whether they are paid to make it easy to reject a claim!!
All of the main MPD's are classified as Cancers and as such your entitled to free prescriptions in England.
Appeal the findings definitely but assemble your evidence.
Pre-existing conditions are often used as a get out of jail card by insurers but the Financial Ombudsman takes a more proportionate view.
Firstly is the pre-existing condition relevant, secondly was it knowingly withheld by you during the application, if not, then the burden is on the insurer to obtain medical records as part of the underwriting process.
Hi Reflex4 I got the e mail, many thanks! Thank you Rubyrubyruby I will be going back today and asking to see my records. Thank you Itc72 the first time I heard the word platelets mentioned was two years after I got my critical illness cover when I was pregnant, even then they told it was nothing to worry about. The next time it was mentioned to me was just before my diagnosis. so I guess i can throw the burden of proof back to the insurace company? Many thanks to all of you for your support! Best wishes, Diana x
Sorry to hear about the issues you appear to be having. I would agree entirely with the advice given above in terms of referring back to your consultant. The following may also be of interest:
I initially investigated making a claim several years ago and was told by my insurers that it wasn't covered. As a result of the advice on this site I resubmitted my claim late last year and was successful. I quoted the Association of British Insurers - who have advised that this condition should now be covered due to it's reclassification as a cancer (as apposed to being a pre-malignant cancer as it was previously classified - which aren't covered by many policies).
I've also enclosed a link to the same website which states that a policy claim cannot be withheld where a customer has unknowingly withheld information. Might be relevant in your case as clearly you were unaware of your condition until well after you took the policy out - even if somehow your doctor seems to think your condition did exist prior to your knowledge.
You are entitled to have access to your medical records from your GP should you wish see them. There is usually a charge for this ranging from £10 to a maximum of £50 - should you consider it necessary.
Hi TrickyDicky, many thanks for you advice it gives me hope that if I am patient I may be successful in the end. I went to see my doctor earlier and after checking my files he has admitted that he has made a mistake and now agrees that the first time I was made aware of the high platelets was at the beginning of my first pregnancy and he has promised to write to the Insurance company to this effect. He was initially adamant that our condition was not a cancer but I showed him the information from WHO and ABI and also stated that his opinion, however misinformed was irrelevant to me, as the insurance company were not disputing that it was a cancer, only that my GP said I was aware of my symptons at the time of the claim. He did relent and his attitude towards me became kinder and supportive to me for the first time. I am now hopeful that my claim will be accepted and will post the outcome of this latest development when I have it. I want to sincerely thank you all for your brilliant advice and support, it made a big difference to this evenings appointment with my doctor. Warmest regards to you all. Diana x
Hi Malachy, so pleased to hear you are on the road to a successful claim now. The attitude of my GP is fine but my haematologists were a bit iffy for a start and tried to put down my condition as depression and didn't think the results would come back positive for PV. Their attitudes changed when I showed them that I had been doing some homework and did know a bit about my condition.
Thank you Aime, I will let you know when I hear. I agree it does seem to help with some professionals to let them know that you have done your homework! I hope your haematologists attitude remains positive towards you now. It definitely helps when the GP's and haematologists support us!
Just a quick update, 2 rejections later and I have finally just found out my critical illness claim has been accepted! Thank you all so much for your advice and support. It just shows sometimes persistence (with a lot of help) can pay off.
I have just been reading that you had a successful critical illness claim after 2 rejections and just wondered how you went about appealing. My husbands claim has just been rejected on the grounds that we with held information about him having raised cholesterol. Obviously this is totally unrelated to the ET he was never treated for it prior to taking out the policy and the cholesterol tests were something he dudnoff his own back he was never told to do them or even told they were particularly high so we didn't realise it was an issue just wondering where we can go from here. It's causing so much stress in our family at the moment on top of everything else 🙁
The fact that there is a blood result in your records doesn't mean you knew. try to see what your doctor wrote in records of consultations in 2002. It could be the 2002 result was never actioned by your GP so how could you be expected to know a blood result you were not told about and hence you were not in a position to declare it. You are entitled to see your records.
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