Experiences with Insurance Companies

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I have reported to the Financial Conduct Authority that companies are still including ME in mental health exclusions which goes against all the guidelines set by insurance bodies. As I didnt have a complaint specific to me they weren't that interested - will try and chase them on it.

I had some good news this week - my claim that has been going on for the last 18 months was decided on last week and they approved it !!!!

I had a mental health exclusion as I had depression when I took out the policy. They tried to refuse it saying that ME was a mental condition, then went through everything else they could - hadn't been ill for long enough (9yrs!), had been active in that time, could go back to work if I had more treatments (mindfulness, cbt and get give good results as shown in PACE trial), would not be permanent etc.

I had to fight against each argument and even with reports from my consultant they just ignored them. Reports from their CMO fabricated information, I had to go through long SAR process to get these reports which they tried to withhold. Also had to have exam by their independent expert. I was expecting them to still refuse after this and had been to see my own indpendent expert as well. Hadnt even had this other report yet but i had sent another letter to them before they made decision, where I criticised their expert and his exam.

Not sure whether this made the difference or if they just got fed up of me. The policy wasn't for a huge amount and they must have spent a lot working on it. I will get the rest of the notes from them under the SAR so hopefully will find out.

I will put everything together so others can use but it will take a while as I am exhausted and body has crashed after the shock (not too bad but enough that i need a rest)

Thank you to everyone that helped me on this with comments and answers to the questions I needed evidence for. Each letter I wrote seemed to be like a mini thesis especially with all the research I had to do in getting all of the information to throw at them. I never thought we would get to the end and get a positive decision without having to go through the ombudsman. It shows it's worth pursuing even against huge odds.

 

[UK]
https://lexisweb.co.uk/cases/2017/october/miley-v-friends-life-ltd

https://www.12kbw.co.uk/david-callow-successful-high-court-permanent-health-insurance-claim/

Potential claimants should consider instructing solicitors and counsel who were successful in the above case.

NB. I had bad experiences with solicitors Royds, now RoydsWithyKing, who advertise in ME charity journals. They instructed barrister Richard Colbey. When I expressed concerns, Royds told me that he had won many cases for them. It only emerged at the final conference that he had not taken a single case to a hearing. He held himself out as having experience of ME, but again at the final conference he revealed that he did not believe in the existence of post-exertional malaise. Whatever the deficiencies of NICE Clinical Guideline 53, it does include post-exertional malaise. He further said that claimants recover as soon as the stress of the court case is lifted. I don’t know what disease he assumed the case referred to, but I for one deteriorated and continue to be worse.

 

lambchambers dot co dot uk/who-can-help-you/barristers/richard-colbey

 

I am very interested.

And congratulations! I hope you'll be soon ok.

 

I know this is an 'advert' for this lawyer but he gives potentially some useful information for Insurance claims re ME/CFS

Andrew Kantor Helps Get Chronic Fatigue Syndrome Sufferers the Benefits They Deserve

https://www.youtube.com/watch?v=2IKyyJUyHak

 

RGA (Reinsurance Group of America, Incorporated (NYSE: RGA) is one of the largest global life and health reinsurance companies. With headquarters in St. Louis, Missouri, RGA supports clients and partners around the world through innovative approaches and customized solutions.)
article
https://www.rgare.com/knowledge-cen...etween-physical-and-mental-health-an-overview
The Connection Between Physical and Mental Health: An Overview

cites this
https://www.canada.ca/content/dam/phac-aspc/ migration/phac-aspc/publicat/hpcdp-pspmc/28-4/ pdf/cdic28-4-4eng.pdf

for which I get page not found(?)

 

The link is broken due to some extra spaces in it - I removed the spaces and got this, which does work: https://www.canada.ca/content/dam/p...blicat/hpcdp-pspmc/28-4/pdf/cdic28-4-4eng.pdf

I wonder how they obtained that figure? The author needs to be taught the difference between a 'mental health disorder' and a normal and natural reaction to terrible circumstances. Becoming depressed/anxious as a result of being struck down by a seriously disabling but stigmatised, trivialised and neglected chronic disease is a normal reaction. That piece is dated 2008; maybe the author has learned since then, or maybe not.