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I'm becoming extremely furious with the way my insurance policy are going. I rang my insurance company that I took out for payment protection against a loan. They have said they won't pay out because it is symptoms from my SAH so therefore a pre-existing condition. I am thinking of cancelling the policy because that prob means they won't pay out for anything because will blame that.

My second insurance company that I rang said I'm the second name on the policy so i'm not covered for sickness only death!

The third insurance company said they don't cover SAH/aneurysm but I may be able to claim under stroke- a cerebrovasular incident resulting in permanent neurological damage. I will check with my consultant tomorrow but for sure but am hoping I can I am having a lot of physical problems still.

Has anyone else been in similar situations? As if I haven't got enough to worry about at the minute! Sorry to rant!

Laura

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Hi Laura,

I haven't any health insurance policy, but I know for a fact that an Insurance company will do their very best with any type of claim, not to pay out ..... they're hoping that you won't challenge them, so it might be worth giving your local Citizens Advice Bureau a call ..... don't cancel your insurance until you seek some advice .... Citizens Advice is free .... so, call them....

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Hi Louise,

I used to handle complaints related to payment protection policies on a regular basis in my previous job so should be able to give you a bit of advice on this one.

I'm becoming extremely furious with the way my insurance policy are going. I rang my insurance company that I took out for payment protection against a loan. They have said they won't pay out because it is symptoms from my SAH so therefore a pre-existing condition. I am thinking of cancelling the policy because that prob means they won't pay out for anything because will blame that.

Did you take out the policy prior to your SAH? If you did, the symptoms are not related to a pre-existing condition and your claim should have been upheld.

However, if the policy was taken out post-SAH, all is not lost. I admit that I haven't read thoroughly into your background - but if you are unable to work through fatigue/depression, you may be able to make a claim as a 'mental health problem' (apologies about the wording, that's how it's officially known in the insurance world!) You'd need supporting evidence from your GP in this case.

My second insurance company that I rang said I'm the second name on the policy so i'm not covered for sickness only death!

Can't help too much on this one - have you tried getting the first named person on the policy to claim for loss of income?

The third insurance company said they don't cover SAH/aneurysm but I may be able to claim under stroke- a cerebrovasular incident resulting in permanent neurological damage. I will check with my consultant tomorrow but for sure but am hoping I can I am having a lot of physical problems still.

I've just googled quickly for 'subarachnoid haemoorage' along with 'ppi', and several of the major insurers defines a stroke as:

Stroke

A cerebrovascular incident producing neurological sequelae and causing at least 25% impairment of whole person functioning, as measured at 6 months after diagnosis. This requires evidence of:

* Infarction of brain tissue; or

* Intracerebral or subarachnoid haemorrhage; or

* Embolisation from an extracranial source.

Payment protection policies are notoriously hard to claim on. From memory, only 4% of people will ever claim on a policy, and from this small percentage, only one in four will get paid out.

My advice to you is as follows:

1. Attempt to claim following the company's guidelines.

2. If the claim is rejected, forward a complaint to the company in writing by recorded delivery. In this letter, advise them that should you not receive a satisfactory response, you will request assistance from the Financial Ombudsman with respect to your claim. In accordance with the Financial Services Authority guidelines, they must issue at least an initial response to you within fourteen days and complete their investigations within forty-five days.

3. If your complaint is not upheld, ask the insurer for a 'Letter of Deadlock'. This letter is required for you to invoke the powers of the Financial Ombudsman and simply advises that neither party could come to an agreement in respect to your claim.

4. Invoke the Financial Ombudsman (see http://www.financial-ombudsman.org.uk). They are a government run organisation that will arbitrate between both parties to yield a satisfactory resolution, generally in your favour! The process is a little long and drawn out, but they are one of the most powerful ways of getting a complaint resolved in your favour.

And most importantly, keep copies of everything received and sent to the insurer. Ideally, deal only in writing so that you have a log of all correspondence. Generally, most call centre workers do not have the greatest understanding of their products - but when you deal with the back office staff (by writing in), you'll generally get a better response.

By the way - I noticed in another of your posts that you are trying to claim through an insurer to pay your mortgage instalments. Are you aware that you should be able to claim for this via the benefits system? I'm afraid that I don't know the specifics, but in my previous line of work I dealt with a large number of cases where people were having their mortgages paid for by the DSS (DWP?) - they would only pay the interest for the mortgage, but the company I worked for were happy for this to happen and expected no additional payment from the customer until they were able to work again.

Hope this helped - if you have any more questions, feel free to ask.

Chris

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Chris,

Thanks for your help. I rang my insurance company yesterday to start the claim for my mortgage. I'm not holding out much hope but will all your steps you never know.

My second policy- Can my husband claim because he didn't lose any earnings. His compant were really good and paid him even when he was off looking after me.

The 3rd policy- I did actually go and see my GP yesterday and he did mention the fatigue/deperssion so I might go back and see him again.

Thanks

Laura

xx

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Hi Laura,

It depends upon how the policy is worded.

Most companies define it as 'loss of income' rather than 'loss of earnings'. You could argue that the term 'income' covers the entire household income rather than just his wage.

Again, the FOS are quite handy in this respect as they can look into policy wording - and will generally pick up on any irregularities/vague wording.

Chris

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Hi Chris

I have recently received payment protection for my mortgage and another loan that i had. They are only asking that i send in the sicknotes from my gp so far.

I do have an endowment that states that if i have a sah/stroke they will make the funds available to me. They have just written to my consultant.

I have friends who work for dwp and a insurance company who are assisting my wife to make the claims.

I do think the list you compiled is super and i will use it if neccessary.

Cheers

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