Legal & General’s claim delays are adding to my trauma after brain surgery

I am 35 with two young children. Seven months ago, I was diagnosed with a brain tumour and underwent emergency surgery. I made a claim on my Legal & General income protection policy as I was signed off work.

I have since undergone 33 sessions of radiotherapy, and two rounds of chemotherapy, all while trying to deal with Legal & General which is poor at replying to emails and providing updates. Every time my doctors provide requested information, it takes weeks to be assessed.

A small caveat is that, when I applied for the insurance six years ago, I ticked “no” to a question about whether I had received treatment or counselling for anxiety, depression or mental illness. I had, the previous year, received cognitive behaviour therapy for low mood, but did not think this applied.

I feel this, and the reason for my claim, are completely unrelated and that Legal & General is now trying to fish for a reason not to pay out.

My statutory sick pay ended last month, and I may be forced to return to work during treatment to pay the mortgage. Legal & General has now offered me £100 compensation for the delay, but implies a decision may still be weeks away.
CL, Witney, Oxfordshire

You have endured a horrifying few months and I’m so sorry. You are right. A course of CBT, which may seem a minor omission to you, is a major sticking point for an insurer. Mood swings can be an early sign of a brain tumour, but insurers have been known to have relied on completely unrelated conditions to avoid a payout. One reader was left over £30,000 out of pocket after being diagnosed with a kidney tumour while on holiday, because she’d failed to inform her insurer of a previous prescription of sleeping pills.

It seems that it was the undeclared therapy that caused the delay in processing your claim, as additional information had to be sought from your doctor. However, that does not justify a seven-month wait or Legal & General’s dilatory communications.

The company informed you that it would pay up within hours of my intervention. It says that it settles 97% of claims, but nine in 10 of those it refuses are due to deliberate or reckless misrepresentation on the claim form.

It says: “We are also very sorry for the delay that occurred in resolving his claim. Although, happily, we were able to pay, we needed to check some information that was not disclosed previously, hence the delay. This highlights the importance of declaring everything at the time of application.”

You were lucky. Guidance from the Association of British Insurers suggests companies make a partial settlement if an omission was merely careless.

Complete honesty doesn’t always pay, however. JC from Glasgow’s 18-year-old has had her critical illness cover quote rescinded by a broker because she took a literal approach to the truth when asked if she smoked.

“When during the screening phone call she was asked if she had ever smoked, she answered that she had once had a couple of puffs on a cigarette,” she writes. “The interviewer immediately said that she would have to revisit the policy, as now she would be classed as a smoker. It’s been confirmed that her premiums will be higher.”

The definition of a smoker for insurance purposes is startlingly wide. Most life insurers, for instance, award you the label if you’ve had a single fag, vape or nicotine patch in the last 12 months. The rationale is that your occasional indulgence could tip at any time into a deadly habit.

As far as the World Health Organisation is concerned, you’re not a smoker until you have got through at least 100 cigarettes over a lifetime. Once you’ve earned the label you can expect to pay up to twice as much in life and critical illness premiums.

Your daughter has two options if you want to avoid the price increase. She could start a new application through a different broker and keep to herself her few rogue puffs (assuming they are only a few) or she can steer clear of all nicotine products for 12 months, after which she can say she is a non-smoker.

And finally, on a happier note…

I write in praise of More Than, which is a brand of RSA. Last month I noticed I had a direct debit going out from a secondary current account to RSA which I couldn’t reconcile.

I discovered this had been the case for at least six years and, eventually, realised it was for home insurance on my previous property, which I sold more than four years ago.

I approached More Than, bracing myself for an argument. However, once I shared evidence of the sale, it immediately refunded the payments for the whole period – more than £2,400.
MD, London

Responsive, empathetic service should, of course, be the norm. The fact you were sufficiently struck to write in shows that it is not. Happy tales reduce my blood pressure, so let’s hear more about the companies who get it right.

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