How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • Go back-and-forth until satisfied
    Rate the answer you receive.
Ask Stuart J Your Own Question
Stuart J
Stuart J, Solicitor
Category: Law
Satisfied Customers: 23122
Experience:  Senior Partner at Berkson Wallace
11292137
Type Your Law Question Here...
Stuart J is online now

It is a question about an health insurance policy Is that

This answer was rated:

Hi It is a question about an health insurance policy Is that something you can help with ?
JA: Where is this? It matters because laws vary by location.
Customer: Uk
JA: What steps have been taken so far?
Customer: Started a claim
JA: Anything else you want the Lawyer to know before I connect you?
Customer: No
Customer: replied 14 days ago.
So I have an income protection policy with a big established company At the time it was sold to me by a financial advisor in my home He asked me my self employed earnings then. Since then I have never seen or heard from him or the company but have been direct debited every month. Now 11 years on when I wish to claim I am told the absolute max I can claim is what I told him I was earning then which is a 6th of what I earn now. I was never told by him that figure would be the ceiling or asked to update my income details. I feel the company should have contacted me annually as all other insurers do to check that the policy still matched my needs.
Do you have any advice as the insurers say there is nothing I can do.

Presumably, you paid amounts of money for an amount of benefit and from what you say, you started that 11 years ago.

If you are still paying the same premium now which you paid 11 years ago, then you would still get the same amount of benefit because the amount of premium that you pay is related to the amount of benefit although not directly in proportion because there are some fixed costs.

I appreciate that the company should have come back to you annually to review the situation and make sure that the policy fitted your needs and what they would have had to have done have course is to increase the premium and if you are now earning six times what you were earning before, in round figures, then you would be paying six times the premium.

 

You cannot course bring a negligence claim against the adviser for failing to advise you further and against the company for failing to review regularly although it’s not something that I would be rushing to court over. What you can do however and which is free, estimated complaint to the Financial Ombudsman Service.

Customer: replied 14 days ago.
At what stage would I complain to the ombudsman I am worried that if I complain now they may not pay me anything at all. Do I have to make a formal complaint to the insurer first ? So far I have queried it verbally and been told that’s just how it is.
Customer: replied 14 days ago.
Prefer to message as I’m ill

If the insurance company say to you, that if you complain to the ombudsman, they will not pay you, then they are in breach of contract, breach of all statutory provisions, and leaving themselves wide open for a complaint and a huge amount of compensation. That is not going to happen so I would make the complaint without worrying about that.

 

I will tell you now, from experience, that it’s unlikely your complaints going to go anywhere because there is no absolute statutory duty or contractual duty to continue to update you.

If the insurance company say to you, that if you complain to the ombudsman, they will not pay you, then they are in breach of contract, breach of all statutory provisions, and leaving themselves wide open for a complaint and a huge amount of compensation. That is not going to happen so I would make the complaint without worrying about that.

 

You were aware that the premium you were paying was the same 11 years later as it was at outset.

Having said that, it wouldn't stop me making the complaint.

Stuart J and other Law Specialists are ready to help you