Hi, I would appreciate any advice, & will try to describe the events as accurately and concise as I can. If I post this in the wrong forum, I will appreciate some guidance as to where it should be.
In 1995, my wife & I took out a joint Critical Illness with Death insurance policy, with, whom we were advised (by the Life Insurance broker, we placed the business through), was one of the new big companies branching into critical illness cover.
At the time, we were both 35 years old, & whilst I worked full-time in an engineering superavisory role, my wife had started a retail business. We have 2 children, then aged 5 and 2 years respectively. The business was only extremely small and we were advised that this Critical Illness/Life Insurance was essential, in the awful event of any serious illness in the future, to our children or ourselves.
All the reasons for taking out this policy were explained to the young Insurance broker. He then worked for a fairly largish local insurance broker, whom we had previously taken various other insurances out with.
All was well, thank goodness, until in approx. 2002, my wife was forced to close our shop, due to undiagnosed and critical (and complicated) gallbladder disease, which eventually involved damage to her pancreas.
Eventually having to plead to be referred to a larger more specialized hospital, for life saving surgery.
As my wife was not diagnosed with cancer, etc., we did not claim on the insurance.
Over the next several years, we struggled on. However, in late 2011, after increasing leg Immobility, etc. issues, and severe worsening electric shock type pain down her neck and body, she was admitted into hospital. We were advised by a new to the area Neurologist that he was 95% certain that she had M.Sclerosis. When she was admitted, she was unable to walk, or balance, and her legs kept giving way, causing bad falls.
She was kept in hospital for approx.. 2 weeks, and one of the medications that was prescribed were Steroids. Within days, she was managing to walk again, albeit with a frame.
We were advised that her eyes were also affected. (Bi-lateral Intranuclear Ophthalmoplecia).
She returned home, and slowly began to recover. But approx. 6 months later, she was admitted into hospital on various occasions, with infections, flare ups of immobility, and increasing electric shock buzzing down her neck, burning/then freezing leg sensations, etc., etc.
We had notified the Insurers about her possibly having M.S. as we had been advised that we were covered for this. However, because of her continuing bouts of further ill-health, some of the tests required to confirm a definite diagnosis of M.S., were delayed.
Unfortunately, my wifes health continued to deteriorate. To such an extent, that following emergency hospital admittance in September, 2012, she became seriously was admitted into ICU, suffering with sudden & severe seizures. The first period of coma was approx. 2 days. She then rallied, but a few days later, she fell into a more lengthier & more serious coma. For over 5 days, we were advised that her life hung in the balance. She was on full life support, and placed on a ventilator. Her GCS level was just 8/15, & we were advised that even if she did wake up, she would probably be brain damaged, etc. During this stage, TWICE my daughters, myself & her parents/siblings, were called to the hospital. Eventually, on the Friday, we were advised that if she did not respond within the following 48 hours, that her ventilator, etc., would be removed. We were advised to expect the worse …. We were all absoloutely devastated. However, after an emotional & extremely difficult several hours, I phoned the hospital consultant & advised him that in no way did the family agree to the DNR approach.
But then, on the Sunday, a miracle happened she opened her eyes for the first time in weeks ! We were absoloutely estatic ! .It was, however, extremely evident that she was still seriously ill. Although she had began to open her eyes, she could not speak, or eat/drink, move around very much. It was a long slow recovery process, but eventually she was well enough to be transferred to HDU, etc. but after almost several weeks, in hospital, we were able to bring her home !
We contacted our Critical Illness cover Insurers to advise that the further tests re: Multiple Sclerosis, had been delayed due to my wife suffering a severe coma and of being in hospital for many weeks.
But The Insurers then contacted us to say that we should file another claim, because the policy covered Coma…
In approx. November, 2012, we submitted a claim to them, regarding this. My wifes Consultant who cared for her during the Coma, wrote a thorough report to them. A few weeks later, came the devastating result that her being in a “longer period” of Coma, did not meet their criteria. EVEN though she had been in what her Consultant insisted was a “DEEP COMA”.
We complained, and they agreed to “reconsider” the claim for Coma, if we could provide further information. They then wrote to the Consultant again, who provided another report. Which the Insurers then informed us AGAIN, did not meet with their “criteria”. We approached them again, requesting an explanation of just WHY they considered this to be.
We also had given them our written permission for them to access my wife’s medical records.
Unfortunately, my wife’s health has continued to significantly deteriorate, since the Coma in late 2012. After the Coma, she began suffering with worsening memory problems, which are now significant.
She then began to lose even more mobility, and began suffering with serious falls. Between approx. 2013 and July, 2017, she has broken both of her legs in various areas, in SEVERAL DIFFERENT PLACES. During which time, she has had to endure approx. TEN different LENGTHY & EXTREMELY PAINFUL CORRECTIVE OPERATIONS.
In approx. 2014, we were advised that my wife was now also suffering with advanced OSTEOPOROSIS. Ever since, she has had to take high-dose medication, to help control her condition.
As previously mentioned, she has now also suffered for many years, with Gallbladder related Pancreatic damage (local hospital damaged pancreatic bile duct during investigation) & now suffers with Chronic Pancreatitis, for which she has to take a large amount of medication to help control the pain . (She has also lost approx. 9 stones in weight, without even trying, over the last several years.)
Last year, I myself had to take Early Retirement. My wife was unable to look after herself., anymore. She now requires more or less around-the-clock care.
In 1995, we NEVER, EVER, envisaged having to live in this kind of situation – we were led to believe that in taking out this insurance, if we DID suffer serious illness, we would be “covered”. Whilst the initial premium for 10 years was only approx. £33 per calander month, the premium has increased in the past 13 years, AGAIN & AGAIN & AGAIN…. In 2 weeks time, unless we increase the premium by another 20%, the cover (which includes LIFE cover) will be reduced by approx. £7,000.
They have “forcasted” that in increasing the premiums by 20% it will “safeguard” our sum insured for approx. 5 years. If we don’t, because of our increasing age, in approx. 2 years time, we will face another massive hike in premiums, etc.
We feel that, because we have NOW PAID IN APPROX. £25,000 IN PREMIUMS, since 1995, we have no other option but to now agree to pay the increased premiums (yet again) – which will now be almost £200 a month, from July, as “at leasT” we still have the life insurance aspect of the policy. (Which is the only Life Insurance we actually have).
So, we feel like we are now waiting to die…
I am so sorry that this post is so lengthy, but hope it is realised how DESPERATE we now are … We are now facing what could become an impovorished and retirement.
The Insurers are aware that we are now considering making a complaint. But because of the terrible ensuing & serious health problems my wife has suffered, since the coma, & all the terrible upheaval her poor health has caused, we have NOT been in a position, to complain beforehand about the Coma Claim being refused, back in 2012/2013.
Although the Insurers DID state in January, 2013 that their CMO had requested her medical records, they never contacted us again about the claim.
Over the years, we have tried several times to speak with the Insurance Broker who sold us the policy in 1995. The existing Company he then worked for has now folded/sold out, etc. & this chap is now an independant “Financial Advisor”. He has given us brief advice, BUT has made it quite clear several times now, that he cannot help further… At one stage he actually advised us that if we could not now afford the now expensive premiums, to cancel the policy …
What a pity he didn’t enlighten us in 1995, of the possibility of this C.I. insurance probably NEVER paying out, however terrible a future illness may become…
Many thanks for persevering in reading this – any constructive ideas gratefully accepted.
We have recently now notified the Insurer again, that we now wish to have the claim reconsidered/looked at again… We have applied to the hospitals involved, to request copies of ALL of my Wife’s medical records & are now await the receipt of these. Obviously, because of how critically ill my wife was, etc., this is taking a little while for the hospital to gather all the relevant information together.
We DO have “Legal Expenses” Insurance connected to our Home Insurance Policy, but do not know whether if this Insurer will actually give advice / or help in putting together a “case” to the C.I. Insurers ?
And in amongst all of this worry, is also all the personal worry, not only about my dear wife’s worsening health and mobility problems, BUT ALSO the increasing worry of our financial position.
We are also not happy at all about the lack of support now, trom the F.A., who sold this insurance to us, in 1995. (But he has made sure that the Insurers are aware that he is now again our F.A., so will probably be receiving a fee from the Insurers, each year) – even though he isn’t willing to help further…
So sorry, folks about the length of all this. But we are now both feeling desperately anxious about the future. If we had known back in 1995, the heartache and pain, if you need to claim, involved with this type of insurance, we would NEVER EVER have taken the policy out. We would have been far better off, saving the equivalent amount of premium money each month, into a savings account, and just taking out Life Insurance, which would of saved us a lot of money.
I look forward to any advice given – we are aware that time is now of the essence, in having this looked at again. As explained, we have not been able to deal with this earlier, due to the severity of my wife’s now complex ill-health problems.
Kind Regards, ChickenMan.