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Standard facing PHI row

Financial Ombudsman Service to probe case after company turned down claim for £20,000 angioplasty.

Standard Life Healthcare is facing legal action over a £20,000 unpaid claim on a group permanent health insurance policy.

DM Cager Insurance Brokers FS manager Martin Dubber believes that his client David Evans has been treated unfairly and is challenging Standard, which says that it is rejecting the claim for the non-disclosure of a pre-existing medical condition.

The Financial Ombudsman Service is currently looking at the claim.

If the FOS claim fails, Dubber says he will take Standard to court for the full amount of claim.

Evans started paying into a Standard Life Healthcare group permanent health insurance scheme on November 1, 2005.

In June 2006, he suffered severe chest pains and, upon referral to a heart consultant, was given an immediate angioplasty, with medical bills totalling £20,000.

Standard is refusing to pay out on the basis that Evans had experienced these symptoms previously.

On March 18, 2005, Evans says he was admitted to Glasgow Royal Infirmary with chest pains but stresses that his electrocardiogram came back clear and he was discharged, with his medical records stating “chest pains due to excessive alcohol consumption”.

Standard’s policy was set up on a moratorium basis, meaning that it excluded treatment for any condition or related condition someone had “received medical treatment for; had symptoms of; asked advice on; or to the best of their knowledge were aware existed” in the five years before the cover started.

Dubber says Standard has no evidence to support its decision, and he believes such decisions bring the industry into disrepute.

He says: “They should hang their heads in shame. My client suffered with some pain over a year before this cover was arranged and he sought medical advice but no diagnosis was made.

“On the basis of this and this alone, Standard Life Healthcare is rejecting his claim leaving him unable to access the follow-up treatment he desperately needs.”

Standard Life Healthcare spokeswoman Mandy Blanks says: “Mr Evans’s claim has been turned down because we believe it is for treatment of a pre-existing condition. Despite this, we did pay for his initial consultations and tests even though these were done at a hospital not on his list.

“Like all insurers, we have to decline a very small proportion of claims each year due to their being for pre-existing conditions.”

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One of the upsides of doing commentaries is that I can write about whatever takes my fancy or has caught my eye recently.

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