Insurance World

ME, also known as chronic fatigue syndrome, is a recognised illness. However, some of the big health insurers see it quite differently, as the case of Miss A demonstrates.

Miss A has been living with ME for eight years, an aggressive form which has kept her wracked with pain and completely unable to work and support herself. Living on benefits totalling Ј180 a week, she depends on her boyfriend and family to look after her.

It could have been very different, because Miss A had permanent health insurance through her employer. The insurer is Swiss Life, and although they did pay out on her claim at first, they decided to stop paying out five years ago. On the terms of the insurance policy, she was receiving a regular income amounting to 75% of her salary – then it stopped, and since then, she has received nothing. She estimates that she is already been denied access to Ј40,000.

So what has Swiss Life got to say on the matter? It’s not so much what they said, but what they DID, that is the real eye opener. Showing a distinct lack of respect for the debilitating illness, they used covert video surveillance to track her movements and gather evidence to prove that she was not worthy to make the claim. They have used footage of Miss A leaving the house to attend a medical appointment, and then going to visit her Mum, to suggest that she would be perfectly capable of doing a day’s work. This is a view that medical experts have soundly rubbished, especially as ME can vary from day to day, leaving sufferers able to perform small tasks one day, and then consigned to bed the next.

Video evidence showing Miss A on her feet would not ever convince a doctor, who knows all too well what effect ME has on people’s lives, but Swiss Life has used the evidence as proof of her being ‘active and mobile’. They also have other criticisms of Miss A which has enabled them to successfully deny her claim; for example, they say they have seen no long-term evidence of her inability to work. They also say that she resisted rehabilitative treatment back in 2002, when in actual fact Miss A was unable to complete the course because she suffered a relapse.

Even a Harley Street doctor and ME specialist has examined Miss A and can verify that she is suffering from ME and is deserving of her health insurance payments. To no avail with Swiss Life. The only way that Miss A can win her case is to take it to the Financial Ombudsman, and they have already said that any compensation will be limited to a maximum of Ј100,000. Miss A is not willing to take the risk, and is distrustful of the Ombudsman. Who can blame her, when she has been treated so badly so far?

Resolution, the owners of Swiss Life, says that they wouldn’t stand in her way if she wanted to progress the case with the Ombudsman.

The problem that Miss A is having is being experienced by many people with what insurers deem to be ‘designer diseases’. The insurers think that people are trying to take them for a ride. The reality is that people are suffering, and they are not receiving the payout they are due. Those looking to buy a health insurance policy should be absolutely sure that the company has a good attitude towards diseases like ME, so if the worst does happen, you will be covered. Try the Internet for the cheapest prices, and for an extensive range of tips and advice.

In recent years sales of critical illness insurance have flagged. The primary cause is the huge 70% increase in premiums experienced during recent years. For many, critical illness insurance has simply priced itself out of the market.

It’s not that critical illness insurance is a bad idea. After all it pays out a lump sum if the policyholder is diagnosed with one of the many critical illnesses listed on the policy and the policyholder survives at least 28 days from diagnosis. (Note: some policies have a 14 day survival period.) Most policies have a huge list of insured illnesses although about 60% of claims are for cancer – not surprising, as 1 in every 3 people will develop cancer sometime in their lifetime. In fact when you look at the concept of Critical illness insurance you can easily make a case that everyone living on earned income should have a policy. It’s designed to give you a pot of capital to live on if serious illness prevents you from working normally.

Premiums have increased dramatically because medical advances have meant that many illnesses that proved fatal in the past are becoming quicker to detect and easier to treat. Hence insurance companies have found themselves paying out earlier on claims and on illnesses which are not necessarily debilitating - which was the original purpose of critical illness insurance.

To give you a better idea of the sort of illnesses we’re talking about, here’s a typical list:

Alzheimer’s Disease

Aorta Graft surgery

Bacterial Meningitis

Blindness

Brain Tumour

Cancer

CJD

Coma

Coronary Artery by-pass surgery

Coronary Artery Angioplasty

Deafness

Heart attack

Heart Valve replacement/repair

HIV/AIDS resulting from blood transfusion

Inability to perform your duties of occupation

Kidney failure

Leukaemia

Loss of limbs

Loss of speech

Major organ transplant

Motor Neuron diseases

Multiple Sclerosis

Occupational HIV/AIDS

Paralysis

Paraplegia

Parkinson’s disease

Stroke

Third Degree burns

Any illness that results in Total and Permanent disability

Insurance companies have at last realised that they’re not going to get anywhere marketing policies that people can’t or won’t afford, and where the companies can’t afford to lower prices. So it now looks as if insurers such as Scottish Widows are considering a break through – splitting the cover so that the prospective policyholder can specify which illnesses he or she wants to insure against. It’s a form of “menu pricing” – cover for each illness would have a price and you simply select which illnesses you want to insure against.

Whether such insurance proves popular will very much depend on the cost. For example, if cancer accounts for around 60% of current claims, you’d expect the premium for covering cancer alone to be about 40% cheaper than a full strength critical illness policy. We’ll have to wait and see.

If you’re interested to find out how much a standard critical illness policy would cost you, you’ll find it cheapest on the Internet. The best sites to look out for are the independent discounting brokers who deal with all the big insurance providers. These brokers can search the whole market for you, come up with the cheapest insurer, and discount their price. Try to use a broker who’ll also give you personal advice on the phone as some policies do vary in the scope of their cover.