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 but and several renewals however, we believed it was reasonable in the circumstances to demonstrate that efforts had been made to update the insurers.
Long story very short, they paid, the full £250,000.00.
We realised very rapidly that actually, far from being the all answering solution to healthcare that everybody thinks private medical insurance is, it actually does turn a great deal of claims away. 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. Insurers are more than happy to turn down a policy holder 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.
If you have had health insurance claims turned away, before you throw the towel in and call it a day, call us.
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.