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IFA accuses Bupa in critical claim clash

A Sheffield IFA has accused Bupa of using delaying tactics over a critical-illness claim by demanding that exceptional conditions were met.

Mint Financial adviser Richard Blackshaw submitted a 119,000 cancer-related claim which took Bupa three months to settle after the ins- urer repeatedly challenged the medical evidence put forward.

The IFA says Bupa verbally rejected the claim last November but, when challenged, said it would reconsider if the client could provide more evidence of the cancer being invasive.

Blackshaw provided a letter from a consultant urologist and histology report stating: “..I have discussed the findings with my pathologist colleague and the lesion has been determined as a superficially invasive moderately differentiated transitional cell carcinoma…”

He was told that because the prognosis was termed “good”, Bupa required a letter from the pathologist directly. Bupa then called the path- ologist to regrade the TNM rating, which grades the sev- erity of a cancer, despite ABI practice only requiring TNM ratings for prostate cancer.

Blackshaw asked Zurich and Friends Provident for their opinions on the case when the claim was initially denied.

Friends Provident spokeswoman Sarah Forster says: “Assuming that full disclosure was made at the time of app- lication, in our chief medical officer’s opinion, the tumour would satisfy the criteria for a claim on a Friends Provident critical-illness contract, as he believes it is invasive.”

Blackshaw says: “It started with this term ‘invasive’. I do not understand how one pro-vider comes back within three days with a yes while Bupa goes through all this. It sounds like their hands are tied though. I blame the reinsurer, they just did not want to pay out.”

Bupa product manager individual protection Steve Casey says: “Although we cannot comment on specific cases, to ensure a claim fulfils a definition, we need all relevant medical evidence. In cases where a point needs clarification, we will request additional evidence.”


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