Aviva has been my life insurance client for over ten years. When I was diagnosed with terminal disease, two years before I told them, they had offered me life insurance.
A drug was prescribed that stopped me from getting cancerous and maintained my life. The treatment is over now. My insurance company was immediately notified.
My consultant advised Aviva that I only had 12 months left to live. I filed a claim.
However, Aviva have declined the claim because my policy ends in May 2022 so, if the doctor is right, I will likely die about 12 weeks after that. Does this seem fair?
Aviva rejected the claim of a customer despite her diagnosis with terminal cancer.
Grace Gausden of This Is Money replies: I’m sorry that you have been diagnosed.
Your consultant advised that you have less than 12 month to live after you stop receiving the chemotherapy for cancer.
Aviva refused to pay your claim under your policy for life insurance.
Aviva said that as your policy is due to come to an end in May 2022, and it is thought you will likely pass away within a couple of months after that date, it cannot pay you.
This is also despite, over the course of ten years, you paying £12,670 towards your life insurance policy.
Aviva’s life insurance policy pays out a cash lump amount to policy holders in the event of death or a diagnosis that leaves them with a terminal condition.
Your claim was denied by the insurance company, who stated that a claim for terminal illness benefit cannot be filed within 12 months of the policy ending.
If a terminal illness specialist determines that the patient is not expected to survive for more than twelve months, then they can receive an early payment of life insurance.
This acceleration allows the customer to arrange their affairs and prevents it from being passed on to beneficiaries.
Aviva stated that the decision by Aviva to deny the claim was made after a review of medical records from the hospital. The review determined that you can expect a life expectancy of 12 months or more due to your successful immunotherapy treatment.
You were concerned that your medical records weren’t sent to you until September, which was the correct time, but they had been due for delivery in November last year. This is because of delays caused by pandemic.
Aviva stated that the customer, after having reviewed her policy, is no longer eligible for any pay-out.
Aviva has not acknowledged that your health conditions have changed significantly in the period between receipt and sending the records.
You will not be able to renew your insurance policy or extend it. This leaves you with very few choices.
Aviva argues that it does not accept the claim, as it details below.
Aviva spokesperson: We are very sympathetic to the customers’ situation.
The terminal illness benefit on her life insurance policy is paid when there is, according to our consulting medical officer and an attending specialist, a shorter life expectancy than 12 months.
Our Consulting Medical Officer, along with a Professor in Oncology, independently reviewed the claim to determine the effect that targeted immunotherapy has had on the customer’s condition.
She has completed her immunotherapy treatment in October.
We reviewed medical records to support this claim. It was found that over 80 percent of those who received this level of care are still alive three years later.
Independently, both experts report that she is clear in her medical records and has a high likelihood of long-term control of the disease. Therefore, the eligibility for terminal illness benefits has been denied.
Based on the customer’s response to treatment and medical data, it is highly probable that her life expectancy could be many years. She will no longer be covered by her policy until her policy ends.
This case has been thoroughly reviewed by us as it is very challenging.
We have an obligation to our customers to evaluate each claim in relation to the policies for them.
Customer who disagree with their insurers’ decision may file a complaint to the Ombudsman
Grace Gausden from This is Money also adds:Aviva believes there is some ambiguity regarding the medical treatment you receive, so it says it will not pay, even though it reviews your case.
It explained why it did so and advised it that it should follow its instructions despite the fact it is ill.
It is now possible to bring the matter to the Financial Ombudsman, who will review it and determine if Aviva acted fair.
The final decision given at the end of this investigation will be binding on them but if you do not agree with it, you can take your insurer to court.
You may disagree with the decision in your case but these procedures might not be the best choice due to how much time it takes to complete them.
However, it serves as an alert to those who have insurance policies and to ensure that they are fully understood in case of such a situation.
Any customers with questions should speak to their insurance company immediately.