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Ask James Mather Your Own Question
James Mather
James Mather,
Category: Law
Satisfied Customers: 22629
Experience:  Senior Partner at Berkson Wallace
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I am a GP with an existing insurance policy to pay out in the

Customer Question

I am a GP with an existing insurance policy to pay out in the event that I need locum cover for sickness. It covers me onward from 13 weeks of absence to 52 weeks of absence. The partners practice agreement covers the first 13 weeks, and after 52 weeks of absence I would no longer be a partner. As the cost of locums has increased over the years, so have the premiums required. At my last financial review, I was advised that an increase was required in order to maintain my level of cover, but that I would be subject to a medical review. I have some on going health problems which have arisen in the last 3 years, not currently causing me to lose any time from work, but nonetheless I fear either weighted premiums or a refusal to extend cover. Given that this is an existing policy, and the increased cover required is to cover cost of living / inflationary price rises , is the company entitled to do this ?

Dr N J stevenson
Submitted: 4 years ago.
Category: Law
Expert:  James Mather replied 4 years ago.

Hello, I am Law Denning and I am a practising solicitor in a High Street practice. I have been an expert on this website in UK law since 2008. During that time, as you appreciate, I have answered thousands of questions from satisfied users on a variety of subjects. Because we are all in practice with clients and court and other users, I might not always respond in minutes, particularly evenings and weekends. Please bear with me in that case

It is my pleasure to try and assist you with this today. Please bear with me
while I gather some further information from you in order for me to be able to
advise you fully.

Unless I have all the facts that I need, my answer would not be accurate.

Why do you think they will refuse cover?
Customer: replied 4 years ago.

I have a condition of my blood which has the potential in some people to turn into myeloma ( not a good outlook if this happens ) - this was picked up in 2010 / 11

Customer: replied 4 years ago.

did you get my reply?

Customer: replied 4 years ago.

I have to go back to work so cannot remain online - please give the best answer you can with the current information

Expert:  James Mather replied 4 years ago.

If you mean, are they are entitled to increase the premiums if you
require increases in the amount of cover (whether due to inflation or for any
other reason) yes they are entitled to do that. It would be most unusual for
them not to be able to do that and indeed it would be even more unusual if they
did not do it.

However whether
they are entitled to refuse to continue with cover at all or increase it
depends on the terms and conditions of the original policy.

If however the increases are due to other problems which have arisen in
the last three years, they are not obliged to give cover if the new conditions
affect the original condition

at this stage, it is
impossible to be more precise without knowing what it says in the original

Customer: replied 4 years ago.

The premiums have been increased at intervals over the years, to keep pace with the increasing cost of a locums - I am not questioning that. These have occurred at intervals with no questions asked of me. This latest increase which I have been advised I need, generated a medical questionnaire and a brief medical examination, because of my age(51) . 3-4 years ago I was found to have the new condition I mentioned above, but which has not had any impact on my previous health, and has not caused me to miss work, but I am under annual surveillance .


Expert:  James Mather replied 4 years ago.
Can I answer any further specific points?
Expert:  James Mather replied 4 years ago.

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