Life Medical questions - accuracy of timelines?

sadie

Registered User
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On Life insurance medical questions, if I mistakenly put down 2008 instead of 2007 for when I had a scan for something - might that policy not pay out in the event of death?
Should I go to my GP and get the exact, exact date of each and every visit and visit for every ailment in the past 5 years?
Do the insurers try to pick holes in someone's medical self-report when a claim is put in?
 
You should be alright, especially as you put it down as more recent that it actually was. They tend to be more concerned with people not telling them of illnesses at all, lying about their age or smoker status to get cheaper premiums.

Seeing as you are worried about it, write to the underwriting dept and clarify the mistake on your proposal. No need to write to your GP, if the insurer wanted more medical details from your GP, you have given them authority to obtain this information themselves.


Steven
www.bluewaterfp.ie
 
I think I understand a bit more.
So if I forgot to tell them I went for a chest x-ray for a cough in 2003, and then died in a train accident 10yrs later, they couldn't not pay out for that by finding out about the chest x-ray.
They would only possibly not pay out if I didn't disclose the condition that I died from, if they found I had had investigations for that before and not told them...
 
The non disclosure doesn't have to be related to what you claim for. You are entering into a contract with them and declare that you have disclosed all material facts to them so they can assess the risk of your application.

If you went for an x-ray for something and didn't disclose, you wouldn't have disclosed all material facts, you would have lied. If you said you had an x-ray in 2008, when it was 2007, you could argue that it wasn't a material fact. If in doubt, always disclose. You don't want your loved ones not getting a pay out over a small issue that comes up at a claim stage.
 
The onus on disclosure is on you.
The Insurance Company may well not pay out any non-disclosure.

Write to them , keep a copy, raise your concerns , ask their advice , then do what they ask. Ensure at the end of it you have it ok,d in writing from them.
In that way both you and Insurer have certainty..
 
Right, so really to be on the safe side I should get my GP to provide a full history and send that to the insurer? All the investigations I've ever had plus the results.
Just remembered I had repetitive strain syndrome, and had an x-ray of my shoulder I've just remembered, I didn't disclose that and can't remember if it was 5, 6 or 7yrs ago.
If I send them a GP report then they can't argue with that surely.
The insurance companies selling you the policies don't seem to be that adamant about you making absolutely sure, to the letter, your medical history. Is it more in their interest that you do or that you don't get it 100% accurate...
 
I always thought that once you declare anything at all they usually write to your doctor for a report which will cover pretty much anything of importance. The average person surely couldn't remember every doctors visit date going back years accurately.
 
Life insurance companies try and pay claims where they can as long as the customer does not make knowingly false declarations such as saying you are a non smoker when you are.

However that said, I dealt with a case last year where a customer took out a life policy to cover a loan back in 2005. He was diagnosed with diabetes in 2003 and did not declare this in the proposal. Roll on 2013 he was diagnosed with lung cancer and subsequently died as a result.

When the claim went in to be assessed, the life company discovered that he had diabetes. The life company could have refused to pay the claim. Instead they said, had they had known that the customer had diabetes they would have loaded the premium by 100% and so reduced the claim by 50%. Their opinion was that the customer did not die as a result of diabetes and so they felt that they had a moral duty to settle the claim.

I had a specified illness case 2 years ago where the customer was diagnosed with prostrate cancer. He had blood tests two weeks before he took specified illness cover where his PSA score was elevated, he did not declare this in the proposal. The life company refused to pay the claim on the basis that they would have declined cover had they known this fact. His defence was that he did not know the results of the blood tests at the time of the proposal and that the blood tests were just routine as part of his annual check up. But this not make any difference and the company refunded all the premiums. This resulted in a complaint to the FSO but the ombudsman upheld the life companies decision.

Obviously you should answer the questions to the best of your ability and not make false declarations and if in doubt refer to your GP. Its not up to you to decide what is relevant and what is not!
 
Slightly off topic but I heard a story yesterday about a fella in his 50's who went to the doctor with a complaint and had an x-ray taken. The doctor asked the man when he'd had his kidney removed. The guy was born with 1 kidney and never knew until he was in his 50's.

I wonder what approach an insurance company would take to that. He never knew or had any reason to suspect there was anything wrong with him but it is an existing condition that would have resulted in a loading of premiums.
 
Hi Steven

In that particular case the concept of "upmost good faith" would be used. The person did not know that he had one kidney and would still be covered. However he would need to declare this information in any future application for life/SIC/PHI.

Here is a real example. Person takes out serious illness cover. 6 weeks after they took out cover their 16 year son get an pain in the groin area. They went to doctor and his son was diagnoised with testicular cancer and also had 6 pea sized tumors in the lung. It was obvious the cancer was there before the application was made but the life office paid out on the basis that there was no symtoms of any condition at time of application. By the way... That was 7 years ago and the son has fully recovered and has went on to have a child him self last year despite being told at the time, the radation would leave him stirile!
 
Baracuda,

Good to hear your positive examples on Insurance Companies, given the negativity they get. Can I put one to you .
Customer has insurance that states they will look @a heart attack if these 3 conditions are present.
1.Chest Pains.
2. Electrocardiograph changes
3. Elevated blood enzymes.
He has shown he clearly had all 3. Company are not paying out because his Heart Specialist says ,probably Myocardial Infarction ie Heart Attack.
The policy was taken out in 05 , and customer is relying on points1 to 3 but getting nowhere?

Any advice please.
 
Hi Gerry

Just to say that i am not a claims specialist. Its just that I have been involved in so many claims with clients over the years.

There is a little clause in most (but not all) Specified Illness Products. For a claim to be admitted the heart attack must be classified as a "Diagnosied Heart Attack" as well as meeting the other 3 definations!

Firstly your customer should request that the life office writes to his doctor outlining why they have declined payment. He should make an appoinment with his doctor to review, he should then bring a copy of the T&C of the SIC cover with him and ask his doctor why he is not being paid.

He may well feel at this stage (rightly or wrongly) that he has a case. If so he should contact his heart specialist and explain to him/her that because he/she has said that this is "probably Mycardial Infraction" it means that the life company will not pay out.

If the heart specialist will not agree to altering the diagnosis from "Probably" to "Diagnosied" he should then seek a second opnion with another heart specialist!
 
Gerry

In addition to Baracuda's answer, check who the insurer is. Aviva and Irish Life (I think) have started using Best Doctors or versions thereof. If his doctor won't confirm heart attack, maybe he can get a second opinion and get the life company to pay for it.
 
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