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Critical illness insurance

Discussion in 'General ME/CFS Discussion' started by Sbag, Jan 11, 2017.

  1. Sbag


    Has anyone had any success with critical illness insurance claims? ME is excluded in my policy but I took it out many years ago along with life insurance to cover a mortgage.
    As it was excluded so many years ago I was wondering if that was because it was then commonly thought of as a mental illness. Do insurance companies have to give reasons for an exclusion? If it is still excluded because of this classification I was wondering if there was any way of getting it changed. There is the clause of disability and proving you wont get better but I know this is extremely difficult and from what I have read nearly everyone gets put under surveillance - is that the case from anyone who has been through a claim?
    Invisible Woman likes this.
  2. charles shepherd

    charles shepherd Senior Member

    You don't say if you are in the UK

    If you are I have attached some general information and advice from The MEA on critical illness insurance problems:

    Many insurance companies have been very reluctant to accept claims from people with ME/CFS in relation to critical illness policies

    Problems often stem from the fact that critical illness policies contain a list of all the medical conditions they will cover, often with detailed inclusion and exclusion clauses attached, and ME/CFS tends not to appear in these lists as a condition that is INCLUDED

    In some cases ME/CFS is actually EXCLUDED - see reference to ME/CFS under encephalitis in the Zurich policy document on page 18:

    So the way to make a claim might be under a section covering total and permanent disability

    However, the small print defining PERMANENT and TOTAL disability can again make this very difficult for people with ME/CFS when the insurer disputes that ME/CFS is a permanent illness, or that it can cause major disability

    To help cover this type of situation, we have an MEA information leaflet that summarises and references all the key published research data on prognosis and permanency in ME/CFS:

    Two cases where people with ME/CFS were refused critical illness cover that are worth looking at if you are in this position:

    From the MEA website:

    And a Financial Ombudsman decision:

    However, there are now cases where people with ME/CFS have persevered with a claim - or involved a solicitor who specialises in this type of claim and succeeded

    Information from Brian Barr - a solicitor who deals with ME/CFS and Fibromyalgia claims:

    We also work with a very good solicitor - James Millar Craig - at Royds Solicitors in London on insurance and legal cases. Contact details Royds are on the back page of ME Essential magazine

    Details posted on MEA Facebook on January 2nd 2016 from a member who had won a critical illness case are below. The full discussion can be accessed using the search facility on MEA Facebook page.


    Anonymous please:

    I'm not sure if you will remember but I once asked the question regarding whether it was possible to claim against a life/critical illness policy I had that also covered me for total and permanent disability.

    At the time, it was of the general opinion that I would be unsuccessful with a classic as ME/CFS is not a critical illness and is not considered to cause total and permanent disability.

    However, I did decide to pursue a claim with Zurich. My original policy was with Allied Dunbar and was a whole-of-life policy taken out in 1998. The claim was submitted in February /March 2015.

    After obtaining extensive medical reports as well as psychological one's, I finally received a decision at the beginning of October 2015.
    I was told by the senior underwriter at Zurich that I had met the qualifying criteria and I was awarded the full amount of the sum assured: £152,000

    I informed the DWP of this award and because it is a lump sum, does not affect my rights to receive Employment and Support Allowance as this is based on my National Insurance contributions.

    I thought this information may be useful to your organisation as it may be of assistance to other sufferers.

    Dr Charles Shepherd
    Hon Medical Adviser, MEA
  3. Old Bones

    Old Bones Senior Member

    I have no experience with critical illness insurance. However, approximately 10 - 15 years ago I was denied Extended Health Care coverage under my husband's group employment policy after being honest on the application form. The Human Resources rep said I was the first person ever denied coverage. She "went up to bat" for me, but was unsuccessful. No explanation was ever provided -- yet another way in which ME patients are discriminated against. With no effective treatments, my claims would have been no larger than the norm, I expect.
    Last edited: Jan 12, 2017
    Invisible Woman likes this.
  4. Sbag


    Yes I am in the UK. Thank you so much for your hugely detailed reply Charles. That has really helped to bring everything together. I had heard of one of the solicitors but not the other. My cover is with Zurich so I will go through all of the info you referenced and then see if I can proceed. Luckily I have a consultant and when I mentioned to him he is happy to support and write letters. Will go through everything later today - thanks x
    TiredSam and Invisible Woman like this.

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