Case Study

"When I heard the words ‘breast cancer’ I thought of my children right away". Hannah (not her real name) was diagnosed with Breast Cancer in 2019 and underwent surgery, chemotherapy and radio therapy right away. Luckily, her Consultants felt they had caught the cancer early and felt they had an excellent chance of curing the condition.

Hannah was financially secure and was paid by her employer for six months; she was hoping to be back on her feet and returning to work before going down to half pay. Unfortunately, the impact of her treatment left Hannah with Neuropathy on one arm and Chronic Fatigue Syndrome (CFS) and she felt unable to return to work. She had never considered making a claim on her Critical Illness policy as she had intended on returning to work and did not realise she could make a claim based entirely on her diagnosis.

Hannah submitted her Critical Illness claim to her insurance provider, they wrote out to her consultant and GP for medical notes, histology reports and medical questionnaire. After assessing this information, the insurance company contacted Hannah to say that they had rejected her Critical Illness claim.

The grounds for this decision was that Hannah had been to see her GP two months after her policy was taken out complaining of shoulder pain that had been there for ‘a few months’. At the time, Hannah had been told this was simply normal aches and pains and was advised to return if the pain got worse or did not improve in three months. Hannah returned to the GP after three months and was referred for further testing which sadly revealed she had breast cancer.

The insurance provider stated that this was proof that symptoms were present prior to the insurance being accepted and this should have been disclosed on her application. They claimed that had Hannah done so, they would have waited for further tests to be conducted, which would have revealed the breast cancer diagnosis.

Hannah made a complaint to the insurance company which they rejected.

“I did not really know where to go. I was constantly tired and the thought of having to do all of this on my own…I was not sure I could go through it." Hannah contacted us as she was concerned that her insurance company had not made the right decision.

When appealing a declined Critical Illness claim it is important to establish the facts. What we do at Resolute Claims is to obtain all the information that the insurance company considered when deciding the outcome of a claim. We will also ask certain questions to ascertain why they have come to a particular conclusion. Once we have all this information, we will apply their practices against legislation and guidelines to ensure that a fair decision had been reached. For Hannah, we managed to claim a successful pay-out of £248,000.

In Hannah’s case we identified that there were several discrepancies between what the insurance company ought to have done compared to what they had done. We put these questions to the insurance company and asked them to review the claim again. After around six weeks they had admitted that they had not assessed Hannah’s claim in line with established processes and paid the full claim.

"I could not have been happier. All along I was made to feel like I’d done something wrong."

Unfortunately, Hannah’s story isn’t unique. With millions of pounds worth of declined Critical Illness claims every week, experts at Resolute Claims will help you appeal a rejected Critical Illness claim. We offer free independent guidance and support if you feel you have been treated unfairly. If you want to speak to us about appealing a rejected Critical Illness claim, call us on 0333 050 8792 or email claims@resclaim.co.uk.