refusal by BUPA to pay claim suffering from dementia

Discussion in 'Legal and financial issues' started by spiderweb, Aug 10, 2018.

  1. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
    Has any one been refused by BUPA to settle a claim when suffering from Dementia and with what result
     
  2. karaokePete

    karaokePete Volunteer Host

    Jul 23, 2017
    2,326
    Male
    N Ireland
    Hello @spiderweb, welcome to the forum.

    It may help other members to answer you question if you gave a little more information about why a claim was refused as health insurance policies can be complicated and commonly exclude pre-existing conditions if not pre agreed.

    If you don't get replies from members it may be worth trying the experts on the help line as they may have encountered the situation previously. The help line details are
    National Dementia Helpline
    0300 222 11 22
    Our helpline advisers are here for you.
    Helpline opening hours:
    Monday to Wednesday 9am – 8pm
    Thursday and Friday 9am – 5pm
    Saturday and Sunday 10am – 4pm

    Beyond that the Financial Ombudsman Service may be of use. Here's a link to their web-site http://www.financial-ombudsman.org.uk/
     
  3. Toony Oony

    Toony Oony Registered User

    Jun 21, 2016
    216
    Hi @spiderweb - welcome from me too.

    As @karaokePete says, some more background would be helpful. However my understanding of all PMI's is that they will only insure against acute conditions (ie those that can improve/be cured with treatment), and not chronic ones (ongoing and incurable). Dementia is considered chronic.
    Therefore as I see the situation, no claims could be made by a PWD for dementia related treatment, but if the PWD needed a joint replacement or cardiac treatment for example, that should be covered.
     
  4. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
    BUPA refuse to pay for op because of Dementia no other reason
     
  5. nitram

    nitram Registered User

    Apr 6, 2011
    15,872
    Male
    North Manchester
    #5 nitram, Aug 10, 2018
    Last edited: Aug 10, 2018
    It might be that 'failure to disclose all medical conditions' ,or similar, rendered the policy void.

    The fact that a condition is not related to dementia might not matter.

    Was dementia diagnosed before or after the contract was started might be relevant.

    With all insurance it is important to read the small print.
     
  6. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,369
    Salford
    From an article in the FT (link below) " Bupa has also just said it will no longer cover his treatment for dementia because it is a “chronic” condition, even though he was paying premiums for nearly 20 years before the illness was diagnosed".
    The article is dated 2009 so it would appear they don't cover dementia and haven't for a while.
    K

    https://www.ft.com/content/6b19d50a-30f4-11de-8196-00144feabdc0
     
  7. Normaleila

    Normaleila Registered User

    Jun 4, 2016
    410
    This is why I'm glad I persuaded my aunt and uncle to stop paying BUPA £500 a month. They'd been paying gradually increasing amounts for 40 years or more. When they were in their 80s I knew they were unlikely to be able to claim for anything - and both later developed dementia .
     
  8. Beate

    Beate Registered User

    May 21, 2014
    10,353
    Female
    London
    It doesn't make sense though as they are not asked to treat the dementia - there is no op for it anyway. They are asked to cover an op for someone who happens to have dementia - why would that be a problem?
     
  9. nitram

    nitram Registered User

    Apr 6, 2011
    15,872
    Male
    North Manchester
    @Beate

    Don't know if it applies to BUPA, non disclosure of all medical conditions is a common reason for policies to become void, disclosure may mean an increased premium.. Not informing of acquired conditions after contract needs a careful read of small print.

    Specificity on dementia a simple operation with GA could become complex because of reaction to anaesthesia making it more expensive.
     
  10. MIA56

    MIA56 Registered User

    Dec 22, 2016
    325
    #10 MIA56, Aug 10, 2018
    Last edited by a moderator: Aug 10, 2018
    If you had a renewable policy disclosure is the main reason for declining a claim

    I was a claims manager for a large company and it’s very complex to comment unless all the facts are known.
    Please appeal to the ombudsman you may not have a valid policy but you could be awarded many years of premiums.
     
  11. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
     
  12. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
    #12 spiderweb, Aug 11, 2018
    Last edited: Aug 11, 2018
    Hello,
    Thank you for info .
     
  13. karaokePete

    karaokePete Volunteer Host

    Jul 23, 2017
    2,326
    Male
    N Ireland
    If you feel you would like to take the matter further I would use the link I provided to the Ombudsman in my previous post. Like MIA56, I worked in claims management at one time and you will get a fair hearing as the Ombudsman will listen to your case and study the full file from the insurers as they are not allowed to hide anything.
     
  14. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
     
  15. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
     
  16. spiderweb

    spiderweb New member

    Aug 10, 2018
    8
    thank you for info dementia diagnosed after contract
     
  17. nitram

    nitram Registered User

    Apr 6, 2011
    15,872
    Male
    North Manchester
    Did the small print say you had to disclose the condition either on diagnosis or renewal.
    You inadvertently might have agreed to 'no change' on renewal.
     

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