I was diagnosed with ET & JAK2+ last month at the age of 29. I joined the forum and had seen that people diagnosed with ET had been paid out on there critical illness policy. I had checked with my husband and he confirmed that we did have a joint policy, so I had decided to put forward a claim. Aviva seem to be 'umming and arring' at the moment on whether to pay! I have seen the form my consultant sent back and the three main questions he was asked:
Exact Diagnosis - to which he put down ET and JAK2+
Is the condition malignant- he ticked yes
Is the condition invasive- he ticked no
From your own experience should Aviva be paying out based on information he has provided?
Also I had read somewhere that the condition is invasive so if anyone could shed some light on whether it is or not.
Best Wishes
Yasmin
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Yasmin86
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i assume that this is a form used for a wide range of cancers. if so "invasive" probably means "will it spread from your lungs to your connective tissue". in that context i guess your consultant is correct?
Yes the form is a generic cancer form so I guess your right it could mean that. It's just I had read on this forum that it was invasive so was a bit confused!
I would think this depends on the definition of 'invasive' in the context of cancers maybe, such as the likely hood of a secondary cancer.
The clotting associated with ET however may in some people effect the heart, brain or liver for instance. Could it be argued then that this is 'invasive?'
I apologise in advance at the length of my response! I too submitted a post regarding CI cover a week or so ago.
I am going through the EXACT same thing at the moment with Aviva. I submitted a claim back in April this year which was denied. I since discovered through this forum, and two other forums I am on, that Aviva have successfully paid out to date 9 patients diagnosed with ET and/or PV without any issues whatsoever. Only yesterday, a lady was told by Aviva that they had paid out on this illness before and it is covered and considered cancer. Some people have been paid within 3 weeks. Mine is still on-going after 7 months!
It is considered invasive because it is present in the body and in the blood (albeit it is not considered a "tumour", "life limiting" or "life threatening") nor can it spread to any other organ in the body as it is contained within the blood. It is also considered a "clonal stem disorder".
My argument with Aviva is consultants may differ in their "vocabulary" of defining ET/PV as a "cancer/disorder/disease". However, this does not alter the fact that the "ILLNESS" itself is covered under their CI policy regardless of how my consultant defines the wording. I still have ET and therefore I have the illness covered. Our claims should be paid out.
The ABI updated their guidelines covering both ET and PV and the wording in the policy was edited. Another helpful article is The WHO released in 2008 which reclassifies ET and PV as "cancers".
Because of some very helpful information from a gentleman on this forum, I requested Aviva reopen my claim, which they have done. They wrote to my consultant yesterday for more "medical information". I also wrote to him providing the information above and said this was the basis of my appeal. Aviva are digging their heels in with me and I intend to take this all the way to the Ombudsman if my claim is denied a second time. From a legal standpoint, I am unaware if a claim can be denied solely on the basis of a consultant's report and/or definition of the disease.
To date, Aviva have not provided me with a rational explanation as to why they have denied my claim on the grounds of "non-invasive and non-malignant" and paid out numerous claims without any questions or debate, moreover whose consultants have used the exact same wording as mine.
I also called the ABI and am awaiting to hear back from them. Aviva are members of the ABI, and although the ABI are not a "regulatory" body, as a member, Aviva are expected to follow their guidelines. However, it is entirely down to the insurance company whether they pay out or not.
I have the ABI press release and updated guidelines which someone kindly forwarded onto me if you want me to forward them onto you?
Thanks Angela for the information. Poor you as it seems really unfair. Aviva will be making a decision on my claim next week so fingers crossed. Please do let me know what the ABI advise you.
My consultant has put in the form that's it is malignant but also that it's not invasive which Maz has confirmed from Prof. Harrison.
So it seems that he's filled out the form correctly.
From the 9 that have claimed from Aviva do you know when they claimed. Any recently claimed?
I believe that at least 3 of the claims have been settled within the past 6 months.
I think each consultant differs in their synopsis of what is invasive and what is malignant but that still should not affect the claim being successful as the illness itself is covered under Aviva's policy.
I am responding to Forwardocho's response that ET and PV are not life limiting or life limiting. We all know that both conditions can develop into MF and AML which are both life changing and unless treated successfully, life limiting so I have to disagree with that comment. Again PV is cancer, as labelled by the WHA in 2011.
I made a successful claim in 2012. I was with Scottish Provident who initially said that my ET was not covered, so it was not straightforward.
What turned it around was some ABI (Association of British Insurers) advice. They had published guidelines to the insurance industry that ET and PV were classified as cancerous and should therefore be covered by CI claims. The link to the press release no longer seems to work, but I have a screen shot of the page and also the accompanying statement, both of which I can email to you if you would like?
Although my consultant was reasonably supportive, at the start of the process he didn't think I had a particularly strong case. So I shared the ABI statement with him. He filled in all the paperwork and helped with the response to two key questions from the insurers claims team: Is ET classified as malignant (yes it is, because it's a clonal disorder) and secondly is it invasive (yes it is because it's present throughout the body in the blood). I appreciate this is not what Professor Harrison said.....
Plenty of people on here who have made successful claims.
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