Aviva Aviva Claim

Discussion in 'Health Insurance and healthcare costs' started by pops, Oct 16, 2011.

  1. pops

    pops Frequent Poster

    Posts:
    76
    As an incentive to join Aviva, the waiting period of 6 months was waived for my husband. He then went to his local GP with a verucca a week later (he didn't know it was a verucca). The treatment was carried out successfully at the GP's and all was well.
    Aviva is now refusing to pay up as they claim a verucca is a pre-existing condition and it makes no difference as to whether it was diagnosed before he joined or not.
    It is not an expensive bill and we can pay for it. What bothers me is that if this had been a serious diagnosis, cancer say, he would not have been covered.
    Is it worth bringing a complaint to the Financial Services Ombudsman about this matter?
    Any advice appreciated.
     
  2. pj111

    pj111 Frequent Poster

    Posts:
    370
    from aviva's website:

    http://www.avivahealth.ie/health-plans/terms-conditions/

    Exclusion periods for pre-existing conditions

    This exclusion applies to all in-patient benefits offered under your plan and cover for out-patient scans.
    If you have a pre-existing condition, as determined on medical advice, then the following exclusion periods will apply before any claim will be paid relating to that condition. Please note that these periods begin to run from the date you first become insured under any health insurance contract and do not start again on becoming a health member with Aviva unless there has been a lapse in cover of over 13 weeks.

    If this exclusion for pre-existing conditions applies, the length of the exclusion period is as follows:
    • persons aged under 55 on date of joining–5 years
    • persons aged 55-59 on date of joining–7 years
    • persons aged 60 or over on date of joining–10 years
    Please note that a pre-existing condition is determined from the date the condition commences rather than the date upon which the member becomes aware of the condition. A pre-existing condition may therefore be present before giving rise to any symptoms or being diagnosed by a doctor.

    The final paragraph is key. If he had rung Aviva, or Quinn or VHI advance of treatment, he would have been told it would have been covered if a new condition but not if it was a pre existing condition.

    You say that he visited 1 week after taking the policy out - pretty conclusive that it was a pre existing condition. Aviva would have written out to the dr. and asked when the first date that the condition commenced. The answer to this question would determine whether it was a new condition or a pre existing condition.

    The rules relating to conditions that already exist are the same with vhi, aviva & quinn.

    If it was an outpatient procedure, it probably would be covered.
     
  3. Adam2011

    Adam2011 Guest

    I would write or email aviva with a request under the data protection act for all data relevant to your claim/policy to be posted to you. On the claim form it will state the onset of symptoms, check if this is correct with your Husband and GP, if there is a discrepancy I would write to Aviva and challenge them on it.