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L&G refuses to pay critical child claim

Legal & General is refusing to pay out a £15,000 critical-illness claim for a child diagnosed with bacterial meningitis in March 2001 despite stating the condition was covered on its key features document.

IFA John Lismore Associates arranged critical-illness cover for a couple and their children in May 2000. Ten months later, their daughter was found to have bacterial meningitis at the age of 13 months.

Despite the L&G key features documentation stating “children&#39s cover will be payable…if they are diagnosed as suffering from bacterial meningitis”, the life office has not paid out, citing small print in its technical guide.

The guide, which is available on request and does not have to be given to clients when the policy is set up, states payments will only be made if there is “permanent neurological effect”. L&G says as there is no medical evidence of lasting neurological damage it will not pay the claim.

L&G claims it told the family six months ago that it was willing to review the decision if it emerges that the child has suffered permanent damage.

John Lismore says: “I cannot stress enough my total disgust with L&G regarding their inability or lack of honour to do the just thing. This family has been through mental torture throughout this sad time and they have lost faith in insurance companies.”

L&G spokesman Peter Timberlake says: “The industry has refined and tightened its definitions of critical illness, which is why technical guides exist. It is important for IFAs and clients to understand what each policy covers. The door is open for the client to come back to us.”

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