Over the past two years, Stewarts has assisted D (a patient referred to our Legal Service following brain injury) and her family in securing over £95,000 in insurance payouts where the insurers initially rejected the claims.

As part of the Legal Service, we assist patients with reviewing insurance policies to establish eligibility and support them with making claims. Insurance policy documents are frequently lengthy and can be confusing with numerous conditions and exclusions to consider. Unfortunately, the process of claiming under these policies can be time-consuming and sometimes overwhelming for both patients who are focusing on rehabilitation following serious injury or illness and their family. However, where successful, the money from claims can provide important financial support to patients at a difficult time, as highlighted by the case study below.

Case study

Our Pro Bono team first met D and her husband as part of the Legal Service in 2018 when she spent many months on a rehabilitation unit following numerous neurological surgeries. D was referred after her husband informed the staff on the unit that they were having difficulties claiming on their critical illness insurance policy.

Critical illness insurance claim

The insurer had outlined to D’s husband that her condition was “too rare” and, therefore, did not benefit from cover under the policy. This was extremely upsetting news for them given how significant the money would be in supporting D and her family during her recovery and beyond. Following the meeting, Stewarts reviewed the insurance policy and contacted the insurer on D’s behalf to discuss the situation.

Stewarts identified that a claim could be commenced under a separate part of the policy that provided for payment where the illnesses resulted in total permanent disability (TPD). Claims for TPD can be notoriously difficult. However, after providing additional evidence and liaising with the insurer, they altered their position and accepted the claim. As a result, a payout of more than £91,000 was secured for D. The client’s husband described this as “a life-changing amount … with which we were able to pay off our mortgage”.

Travel insurance claim

In early 2020, D experienced further frustration with making a claim, this time under their travel insurance policy. She returned to Stewarts for support. D and her husband had booked to take their children on a “trip of a lifetime” to Florida, which would be the first trip they had been able to take since D had been unwell. However, shortly before the trip in March, they had to cancel the trip when one of their daughters displayed symptoms of Covid-19. In light of emerging government guidance regarding isolating, D had been concerned about whether they should go and called NHS 111 who advised they should not travel.

D claimed to recover the money from the travel insurer but was informed that as she could not provide evidence of the advice she received from NHS 111, the insurer would not accept the claim. Much to D’s dismay, upon contacting NHS 111 it appeared the recording of the call had been lost. D’s husband described their despair: “My wife and I tried to fight the insurer’s stance until we felt we had reached a point where we had exhausted all our options. Out of desperation, we once again contacted Stewarts.”

Understandably, D and her husband felt like the insurer was penalising them for responsibly following the government and NHS’s Covid-19 guidance. They had appealed the insurer’s decision to the Financial Ombudsman Service to no avail. Stewarts immediately contacted both the insurer and the Ombudsman outlining that this response was not reasonable, and supplied additional evidence that the call to NHS 111 had been placed that day. On reviewing the complaint, the Ombudsman sided with Stewarts, agreeing that D should not be held accountable for the call recording being unavailable. It was clear they had sought the advice that resulted in the cancellation of the trip.

Following the decision, the insurer immediately contacted D to confirm they would now be paying out for the full holiday costs (over £4,000). Now D and her husband have recovered the money, they hope to take their trip to Florida together as a family once it is safe to do so.

D’s husband had the following to say about their experience of the Legal Service:

“In summary, my wife and I would like very much to take this opportunity to say just how very grateful we are to Stewarts. Please keep doing what you’re doing, you make a huge difference to everyday people’s circumstances often when they and their families are at their lowest ebb. You give people like my wife, and I hope at times when it feels like we have no right to be hopeful.”

This article was written by our Paralegal Emily Charlesworth

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