View more on these topics

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.”

Recommended

AMI recruits latest member

Rooftop Mortgages is the latest lender to join the Association of Mortgage Intermediaries as an associate member.Rooftop Mortgages managing director Jonathan Naylor says of the announcement: “We have been impressed with AMIs recent achievements with the industrys regulators, as well as its continued support of the intermediary community. We wanted to be an active part […]

Tory support for debt centres

Conservative Shadow Trade and Industry Secretary Alan Duncan this week visited Blackfriars Advice Centre and Southwark Credit Union to show support for responsible borrowing and organisations set up to aid those with personal debt problems.

FSCS set to pay back 42m surplus

The Financial Services Compensation Scheme is to refund 42m to firms in the general insurance contribution group, partly due lower than anticipated compensation in the sector. It says it is unlikely to raise the levy in 2006/07.

Ship rejects MPs’ claims over equity-release ads

Safe Home Income Plans has hit back at Labour backbenchers’ claims of flawed equity-release advertising, saying increased competition this year will boost product innovation. But trouble could be brewing, with a Ship member survey predicting that equity-release products could be aimed at younger people this year. Labour MPs have accused Norwich Union and other equity-release […]

Newsletter

News and expert analysis straight to your inbox

Sign up

Comments

    Leave a comment

    Close

    Why register with Money Marketing ?

    Providing trusted insight for professional advisers.  Since 1985 Money Marketing has helped promote and analyse the financial adviser community in the UK and continues to be the trusted industry brand for independent insight and advice.

    News & analysis delivered directly to your inbox
    Register today to receive our range of news alerts including daily and weekly briefings

    Money Marketing Events
    Be the first to hear about our industry leading conferences, awards, roundtables and more.

    Research and insight
    Take part in and see the results of Money Marketing's flagship investigations into industry trends.

    Have your say
    Only registered users can post comments. As the voice of the adviser community, our content generates robust debate. Sign up today and make your voice heard.

    Register now

    Having problems?

    Contact us on +44 (0)20 7292 3712

    Lines are open Monday to Friday 9:00am -5.00pm

    Email: customerservices@moneymarketing.com