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I gave them consent as follows 'I agree to you consulting any doctor I have consulted about my physical or mental health....' On contacting Canada Life they stated the doctor did not just mean my GP. The OT actually stated in her replay that she was not a doctor. Also the actual permission to Doctor was over 2 years old is this unlimited time wise. The defamation comes in a letter from Canada Life to the Financial Ombudsman Service where they stated 'Whilst we sympathise with Mr Armstrong's position, we have experienced difficulty in explaining the workings of the policy to him. As a result he has attempted to make certain facts "fit" in an attempt to persuade Canada Life that he has a valid claim, and is now concentrating on the medical evidence which in our view is irrelevant.' I was turned down in a critical illness claim for loss of Independent Existence as I suffer from diabetes. Even though the diabetes has nothing to do with what I am claiming for and is not listed in policy exclusions. They did not think it was libel as letter was not addressed to me.
Not sure if this comes under Scots or English law as my employer and the insurance company are based in England but the OT and I live in Scotland.
It is a group policy which covers all employees without the need for medical or health declaration. This was confirmed by my employer. It is usual for the risk of those who may have some health problem will be covered by the other 99% of employees who are healthy. I advised them I had diabetes at the time of the claim so there was no non disclosure involved. I supplied the evidence that I met the 3 out of 6 conditions (attached). After initially totally ignoring this Canada Life said this statement did not support
my claim! I have also provided evidence in support of my claim from my diabetic and rheumatology consultants. I am at my wits end to think what they actually will accept as proof. however the y rejected my claim as I was a diabetic which is not applicable to my claim based on how I read the policy. Please note I have worked in the insurance industry for 20 years. It was a year after the original claim which they first turned down as diabetic Neuropathy was not covered by the policy. I advised them that as it was LIE I was claiming for and my symptoms were caused by Osteoarthritis that this was irrelevant. They them turned it down because I was a diabetic. Thi FOS initially agreed with their decision but the adjudicator like the insurer totally ignored that the claim was made due to Osteoarthritis and not diabetes and seemed totally oblivious to the fact that you have to say in the policy wording what is and is not covered. Diabetes as I have said is mentioned but only for specific illnesses. It is not an exclusion for LIE nor is there any specific illness you must have to qualify for LIE.
Still doesn't alter the fact that they declined the claim not because I didn't meet the criteria but that I was a diabetic. I have checked the permission given and it is as stated only for a doctor so surely the insurer must have been aware of this and the OT's reply refers to the copy of the permission they sent her by saying she is not a doctor, should have stopped her replying as well. I assume I will have to take this up with the local NHS authority. The insurer were taking the OT's letter out of context saying it said I was fit to work as well which the OT has subsequently totally refuted. Will I need legal help going to the local authority or cant it be handled by myself?
I meant complain to the local NHS about the OT giving out details without my permission. She did actually provide information from my medical file. Like you I can see no relevance between my claim under LIE and being diabetic. I could if I had an amputation or kidney failure directly related to diabetes but yet again I cannot see this in the policy exclusions.
I haven't actually lost the case with the FOS, the adjudicator who unfortunately for me has just joined as a graduate and is a trainee with no experience in the field, agreed that diabetes was excluded but the case has now been escalated to an ombudsman who hopefully will not be fooled by the small print that is irrelevant.
Thank you for your help. Sorry for adding extra information but glad to see that I wasn't imagining things about the policy document.