All Solicitors approved by Law-Med are authorised and regulated by the Solicitors Regulatory Authority and carry  full indemnification 

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Law-Med Solicitors

Blake House

Blake Street

York

YO1 8QG

Call Free 0800-009-6312

Life and Medical Insurance Claims

HAVE YOU BEEN DENIED AN INSURANCE CLAIM

 

Many insurance claims are declined for alleged non-disclosure – often of an unrelated medical symptom or condition. Sadly this tactic is generally used against widows and the bereaved families of the policyholder. The dispute typically arises at the worst time when vulnerability is high.

We have found that very often the medical history on application forms for insurance cover are completed from memory but once a claim is actually made the insurer has a peculiar insistence on going through the clinical history word by word, letter by letter line by line. These “small print” denials are stock in trade for Health Insurance.  Insurers will attempt to decline or reduce perfectly reasonable claims often due to allegations on non-disclosure or other breaches of policy conditions or exclusions. Often these technical arguments are either unfounded or misinterpreted deliberately by insurers. Do not be bullied.

 

HOW WE CAN HELP YOU

If you have a critical illness claim or fatal accident claim regardless of whether this is a refusal on grounds of innocent, deliberate, or inadvertent non-disclosure, or other policy term contact us for an assessment of your case.  We will fully consider your individual case and advise you whether you have a potential claim. This often involves careful consideration of your Policy and medical history.  Surprisingly one in five life and critical illness policies are rejected by Insurance Companies but less than 1 in 1000 are challenged. A large number of these rejections are unfair. It can be hard to take on an Insurance "Giant" by yourself, something that we fully understand from first-hand experience.

To maximise your chances of challenging the decision we can assist you in finding your way to a fair resolution of your claim with expert understanding and skilled legal strategy. The sorts of insurance disputes we have successfully resolved for our clients include claims on:  Travel Insurance ,Life and Health Insurance,, Income Replacement Insurance

All cases are dealt with on a no win, no fee basis. There is no upfront or unexpected costs.

The Great Medical Insurance Claim Payout!

Some time ago, we were approached by a young lady who had taken out life insurance on the part of her husband. About 8 years later he, tragically died after a fatal heart attack. The insurance company indicated that he had high blood pressure and periodontal disease and therefore (both were on the form and ticked no at the time of taking out the insurance) there could be no payment. 

We looked carefully at this and neither condition was diagnosed at the time of taking out the policy. There was however, some overlap with the hypertension however, the evidence that this was causative of the condition that proved fatal was not conclusive, there was in fact a good degree of control exhibited and there was no indication that the two matters were in fact demonstrably related. In fact the Insurers had reviewed the policy and inspected the notes several renewals had in fact taken place and we believed it was reasonable in the circumstances to demonstrate that efforts had been made to update the insurers.

We realised very rapidly that actually, far from being the all answering solution to financial security that everybody thinks private medical life insurance is, it actually does regularly cause a great deal of problems for the policyholders family . Given the huge sums of money invested in these policies we are somewhat surprised that this should be true. In most cases that we take, we have found that the insurers are often relying upon very junior medical advice and frankly, its often quite wrong or places a high degree of confidence in evidence that is challengable. Insurers are more than happy to turn down a policy holders estate as they know that very very few of these policy decisions are ever challenged in the courts. 

We want to change that. 

Since that first approach we have been involved in travel insurance claims, for illness abroad, dental insurance claims where there has been a refusal to undertake corrective work, health litigation in both EU and the UK for private health insurance and even cosmetic surgery claims completed on a company health scheme. Life Insurance claims however, make up the bulk of this work. 

If you have had health or life insurance claims turned away, before you throw the towel in and call it a day, call us. 

Compulsory Arbitration

Many insurers now insert a compulsory arbitration clause into domestic insurance and assurance contracts. What this means is that they will attempt to deny you the right to have your say in Court by referral to arbitration. This may or may not be enforceable against you however, it is nothing to worry about, the main thing is that the arbitrator is one that we can all trust. If this so, then 9 times out of 10 that is half the battle won. 

However, it is because of this arbitration clause that we have to fund these claims somewhat differently. They are funded on a contingency fee basis, this means that we take a proportion of the award. Because at the outset the risks are not clear and because this is litigation that requires a very high degree of expertise we set the amount at 30% for these claims. We are very upfront about this and you will never pay more than this from your winnings of course, if you lose you will pay nothing.