An IFA’s year-long fight for her client has resulted in £220,000 finally being awarded in a critical-illness claim which had been rejected twice.
Square Mile Wealth managing director Jane Robinson pushed for the payout for a client who permanently lost the use of both legs after a fall. She is questioning whether the ABI’s consultation on tightening CI definitions will improve claims, particularly for “grey claims”.
Norwich Union rejected Ben Hooper’s claim under total and permanent disability claim criteria. Robinson argued it should have been assessed under paralysis/paraplegia but a second reassessment under paralysis/paraplegia was declined when a consultant’s examination revealed that Hooper had some muscular movement.
Another appeal resulted in payment once NU accepted he would never regain the use of his legs. NU says the case was a complex one which did not fit into any of its criteria.
Robinson says: “The ABI consultation means tiered definitions will provide even more subjectivity. I think it is the moral obligation for an adv- iser to fight as much as poss- ible for a client in the spirit of best advice.”
Hooper says: “Under any other circumstances, I would have accepted the original rejection. It is only because of Jane that we decided to challenge them.”
An NU spokesman says: “Due to the complexity of this particular claim, the critical-illness policy provided a number of potential routes to claim.”