Critical Illness Claim - My Story

Hi everyone,

I am writing this post in hope I can help others who may be in a similar position.

I was diagnosed with a duodenal NET in December 2017. Since then I had Whipple surgery and the tumour removed successfully. My malignant tumour and graded as 1 and my consultant advised me to inform my insurance. I put in a claim with my insurance soon after for them to then decline my claim under their exclusion 'Having low malignant potential'

I complained to Zurich multiple times but putting it bluntly they didn't care! I knew back then this wouldn't be easy going forward.

I took my case to the financial ombudsman and their adjudicators sided with Zurich within a week. It was then sent higher up to an actual ombudsman. I assumed going to the FO that an ombudsman would review it first but this isn't the case! If any adjudicator declines your claim - complain and take it higher! My mum told me to phone the Macmillan financial team as they had helped her a few years back. They were the biggest help to me in my case & they believed the claim should be paid.

At one point (before Macmillan got involved) I felt so alone in all of this. Your mind plays tricks on you and my insurance tried persuading me that I didn't have what I did have! I thought to myself - maybe I'm wrong, did I REALLY have cancer? because if I did SURELY Zurich would pay... 

Cancer definition in their policy states: 

Cancer – excluding less advanced cases Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.

The term malignant tumour includes: • Leukaemia • Sarcoma • Lymphoma (except cutaneous lymphoma – lymphoma confined to the skin).

The following are not covered: • All cancers which are histologically classified as any of the following: – Pre malignant; – Non-invasive; – Cancer in situ; – Having borderline malignancy; or – Having low malignant potential  

Zurich basically said because I was treated and i'm now 'fine'! They tried every excuse you could think of. Reading their emails and letter infuriated me. They wrote to my consultant numerous times asking the same questions & even questioned his opinion! 

They agreed in their final letter the tumour was malignant but said they wouldn't pay because the grade wasn't high enough. Nothing in there T&C's goes into this detail. It was like talking to a brick wall and was shocking to see the things they come out with.

The FO decided Zurich should pay the claim with interest. I was so happy!! Finally after a year they are paying me! 

Throughout the whole ordeal I felt like I was fighting a loosing battle and creating stress I didn't need after going through such a horrible time.

Many times I felt like giving up. Zurich made me feel like I was wrong and at points didn’t even have cancer when I most certainly did! My mind was playing tricks on me.

It frustrated me as I could imagine Zurich declining claims and people accepting this. Depending on what else is going on you may not have time to fight against them!

PLEASE DO! If you KNOW you are right you most likely are. 

Macmillan financial guide will be able to tell you if you have a case or not. Fight it to the end and don’t believe you can’t beat the big man. I did!! 

I can't stress enough how upsetting the whole ordeal was. To be told at 24 years old you have a rare type of cancer and then have to deal with this for over a year later really tested my mental health. I should of been able to move on with my life after having cancer and avoid being stressed but Zurich made this impossible. 

I might be on my own on this one and insurance companies pay out on most claims. I wouldn’t be surprised if they did this to other people like me.. Another thing that annoyed me was they were wasting Macmillans time and my hospitals time. The hospital are treating people and saving lives like they saved mine! 

It took 13 months to receive payment but worth it. The feeling of beating them was amazing - sticking it to the man 

The Macmillan team did such a fantastic job and I can't thank them enough. Without them I wouldn't be writing this now.

Cheers

Rosie x