Key
Points
·
It is clear a mechanism is in place that does not
require medical opinion to reject a claim.
·
Delegated authority given to an administrator
·
Use of information not available to anyone else at the
time to categorically state what no one else could possibly do - "absolute
certainty of…”
·
Twice extended the endowment policy - 4
endorsements effective 1st September 1992 and 11 more effective 1st January
1996 - all with the "pre-existing condition"
clause.
…in addition to big four
Heart Attack, Stroke, Cancer and Coronary Artery Bypass Graft (CABG)
which do not have a "pre-existing condition" clause
·
A silent infarction would by definition be an unknown
event but would be cited as a pre-existing condition that presaged a myocardial
infarction from the later medical history. Such an unknown event would fail a
claim.
·
Any congenital defect (aneurysm
in artery or atrial septal defect) would also be grounds
for refusal. Defects from before birth not discovered possibly till 30 or 40
years of age. These are the "impossible" claims.
·
Parkinson's Disease.
Use of Levodopa implies advanced PD. Early non-critical
PD is a pre-existing condition. No successful claims for years yet.
·
How many motor neurone disease
claims?
·
Heart Disease - Valve repair/replacement
and Aorta Surgery. Minimally invasive (Port-Access)
surgery does not require "opening the chest wall".
…Heart Valve Surgery is
Open Heart Surgery using conventional techniques. Statistics demonstrate that
only 20% will survive an aortic rupture of any kind.
A purely aortic aneurysm very, very much less than this 20%.
·
When does a Benign Brain Tumour become a terminal
illness?
·
Consultants validate the claim and provide circumstantial
evidence only. GP supplies salient historical information. Once the condition
has been revealed it becomes easy to assign various abnormalities to a known
condition. Retrospectively.
·
…access to the full medical history so it is easy to
select alleged associated symptom(s).
·
Confusing probability with certainty. Accepted by the
Ombudsman that I could not have had any earlier knowledge…