How ill do you have to be to have a successful
claim on Income Protection Insurance?
Chris Hargreaves' Story
My name is Chris and this is my story about useless insurance that’s not worth the paper its written on. I spent 3 months in hospital, had nearly a year off work and am involved in a 2.5 year fight to win a claim on an income protection policy.
In May/June 2009 I was suffering from shortness of breath and spent up to 18 hours in bed. I had been to my GP and hospital but was always told there was nothing up with me so I went private.
The private consultant took one look at me and ordered an emergency blood test which resulted in the hospital calling me and telling me I was critically ill and to get someone to bring me to hospital straight away. On arrival I was told I had a haemoglobin of 5.5 (normal rate 15-16, with emergency blood transfusions at 8) which was critically low and that I needed emergency blood transfusions. These were started straight away with me also being placed on drips and oxygen but as I was still losing blood internally I had to have more. I was then sent for a CT Scan which resulted in me having a reaction to the dye which left me on drips and oxygen for two days.
After recovering from this I was then sent for an operation which I had many times previously but the consultant decided to do it without any drugs which meant I felt him cutting me internally resulting in me screaming on the operating table. Due to this I was unable to go to the toilet which led to me being left in agony. The pain got so bad I was put on morphine and it was only after a family friend suggested an infection did we get the right drugs to fight the pain. My wife and I were then informed I had cancer and would need my bowl removing but it would be better to have this operation at another hospital. I then noticed my legs would go bright red and then within 10 minutes my legs would start doing the River Dance all on their own and when I was made to lie on my back it took over my whole body looking like I was having a fit or seizure.
I was put on two further drugs amitriptyline (powerful anti-depressant and gabapentin epileptic drug) which left me confused and to add to this I was also put on tramadol and diazepam. I had been bed bound for around 3 weeks and tried to start walking but fainted so was stopped from doing this and I was suffering from serious chest pains. I was given ECG after ECG and had to wear heart monitors but they could not find any reason why I was suffering chest pains. My wife and family would visit but I was so out of it I did not even know they had been to visit.
Finally after 4 weeks I was transferred to hospital number 2. They did another CT Scan and found I had a large PE on my lung and started me on warfarin which only made my internal bleeding worse which still had not be found where I was bleeding from. I continued to have daily fits again without explanation. I was in this hospital for around 2 weeks before I was transferred to hospital 3 where I believed I would be treated for cancer.
The thrid hospital did not believe I had a blood clot so did the tests again as the previous hospitals sent me without any notes. It was confirmed I had a clot but as I needed an operation the hospital treated me with Fragmin only. I had the same operation as the first hospital and afterwards was told I did not have cancer and would be able to keep my bowl. For nearly six weeks I was worried sick along with my wife and family for nothing. The hospital then tried to stabilise my HB and INR but struggled as the bleeding would not stop. One night I had a really bad fit where I thought I was going to die and all I remember was a doctor on top of me banging on my chest. The following day I awoke to find all my arm was black as the ace of spades where I had been given an epilepsy injection and I was on all sorts of drips and machines and that day I was told I had epilepsy and would have to inform the DVLA which as a chauffeur meant I would lose everything including my business.
I had been in this hospital for approximately 3 weeks by this point and then they tried to discharge me but my family fought for another opinion which I got 4 days later to be told my fits were in fact caused by tramadol and were not epilepsy as they lasted for hours not seconds. I stopped all medication except warfarin and fragmin which resulted in horrific withdrawals but I have never had a fit since. I was then discharged with a HB of 9.4 and sent home without Fragmin as my INR was only 1.6 which according to the NHS website meant I should never have been discharged. It took 3 days to discharge me as nobody wanted to sign my discharge letter. Two days later I had an appointment with my local hospital regards my clot and continued treatment but I collapsed after only walking a few yards and was readmitted to hospital. The following day I was sent home with fragmin injections but again I was unwell when I went back to hospital two days later. The sister told me I should have been weighed and as a result sent home without enough fragmin.
I was at hospital 3 times a week for 3 months as they battled to stabilise my HB and INR and it was made worse by the fact my body could not cope with the high dose of warfarin and this is when my fight started with Scottish Provident.
Letters and Campaign
After going through everything explained prior to the letters we then started our claim on my income protection policy which was in place to protect my income if I was unable to work. The issue with the policies is the definitions. There are two types of Income
Protection and Critical Illness Cover policies:
Own Occupation – This pays out in the event you cannot do your job and mutual and friendly insurers pay out up to 98% of claims with non mutuals paying out 91% of claims.
Activities of Daily Living/Activities of Daily Working – This policy pays out only if you are unable to do a list of 6 set tasks but can be up to 8. You have to be unable to do at least 2-3 of these tasks to get a payout (tasks are listed in my FOS letters).
Friendly and mutual insurers stick clear of these definitions as they don’t want confusion and if you can’t do your job they want to pay out. No insurer discloses payout figures on these definitions but is widely believed that at least 55% are refused.
Please also check out our campaign. We are NOT anti-insurance, we just want fair treatment for all policyholders and to stop any other person or family having their lives ruined when they try to make a claim in their hour of need.
If you would like to get in touch with Chris, or need any advice, please feel free to contact us.