PAX Insurance BEWARE Correct forum this time

Discussion in 'Finance, Property, Law' started by spr5623, Nov 20, 2006.

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  1. Hi, posted in the correct forum this time hopefully.
    Has anyone had a claim to PAX refused? I signed up to PAX and took out family cover, and whilst in Iraq my wife had a Brain Aneurysm/stroke that haemoraged. We claimed a month or so ago on our critical illness cover. However they are not paying because I signed the policy without informing them that my wife had received treatment from a doctor in the past 2 years, even though this was unrelated and in no way connected to her present condition. As anyone who has passed through Chilwell will know, the whole process of signing upto PAX is somewhat rushed in the manor of the sausage factory, eg, sign here, sign there, date it.
    At the present time I am trying to put together a list of people who have been refused claims by PAX for similar reasons with a view to taking all the cases to the Financial Ombudsman to act against Pax. Anyone who has found themselves in a similar position please contact me. Jeff
  2. The_Duke

    The_Duke LE Moderator


    The financial ombudsman will not be bothered about numbers of cases, each case will be reviewed in it's own rights. You do not have any contractual relationship with anyone else who has had this problem, and so the Ombudsman could not discuss their cases with you. You would be best served to push your own case with them and get the result you want, rather than go for what the Americans call "class action".

    In your case, your failure to notify them about your wife's treatment is classed as "non-disclosure". The key issue is whether it is "material" or "non-material" to the claim in question.

    If your wife's previous treatment is an any way related to a disorder of the brain, or cardio vasular (particularly high blood pressure) then they may be within their rights to link the non-disclosure to the claim. If the treatment was for a non related condition, then they would be unlikely to be able to use it as a defence.

    Your first port of call is to use the complaints procedure shown on the wording, and then escalate it to the ombudsman. I would advise that you use the correct procedure, as there is a tendancy for confusion if people try and avoid certain stages which often causes more delays.

    PM me if you want to discuss this in more detail. I am very happy to give you a bit of help and advice on this one if you want it.

  3. The_Duke's advice is spot on.

    It has long been a basic tenet of insurance that the proposer must disclose any 'material fact', whether or not it has any relevance in their view.

    You may find this article from the Financial Ombudsman helpful.
  4. Something is flashing in my mind about Insurance Contracts being of "utmost faith" or "utmost honesty" or something :?

    Essentially, if you don't declare it, then your insurance is invalid.

    Don't quote me on it though.
  5. The_Duke

    The_Duke LE Moderator


    The phrase is "utmost good faith" and is based on the premise that the person seeking the insurance is the only person in full posession of the facts. However, there is also scope for human error, which is where the materiality of non-disclosure becomes relevant. A non material non disclosure will not automatically invalidate your insurance, but may have an impact on the benefit paid. Each case is reviewed in the light of the facts relating to that case, so absolute answers are not easy to provide.

  6. As my wench is a director of insurance company (and I was a regional director of another insurance body), I can confirm that the first action of most insurance companies upon receiving a sizeable claim is to reject it by poring over the policy and finding an exclusion or excuse to deny/reject the claim.

    As stated, if your failure to disclose the correct information is held to have had no influence on your wife's illness (I hope she gets better btw) then the insurance company will have to pay up. They normally do this before it reaches the Ombudsman, but be prepared to fight all the way.

    Why do they do this? Because over 15% of all claims are fake, and over 50% of 'genuine' claims have been inflated.

    I hope that your error in completing the paperwork does not bite you.
  7. Good to see the MoD didn't waste all the money they paid for my token education. It also proves that I don't talk complete b0llocks all the time :D

    Cheers Duke.
  8. Jeff,

    As the points you make are reflected elsewhere on the forum I have taken the liberty in attaching my reply below.

    I was called by RMTC at midday based on your concerns and I believe that Pat Weber, Head of our claims department, called you personally this afternoon. I joined AIG(Europe) - the insurance company behind PAX - after 16 years in the Army and take our responsibilities to service personnel very seriously.

    To that end, all briefings at RMTC are now conducted by AIG employees. Whilst I have every confidence in the RAO staff who conducted them previously, care is taken by my team to remind soldiers that they should disclose previous medical conditions if they are applying for the Life Cover and not just the basic Personal Accident Policy. This is particularly important for partners who have not been in the military and thus may suffer from medical conditions such as diabetes, cancer etc. As has been noted above, failure to disclose important medical information may invalidate any Life insurance policy. In addition all those who enrol are recommended to retain the policy document which lists all the terms and conditions, and are given the freephone enquiries number.

    As we are controlled by the FSA you can get the information you are seeking from other forum members by writing to our Compliance Team - I believe that Pat has sent the necessary information and prepaid envelope to do so.

    In the meantime, I hope that your wife's condition improves and that she is back at home again soon.

    Dread, this is not the case with PAX - in fact our claims team visit service personnel in Selly Oak Hospital with the express intention of expediting claims. I am very keen that all those who can receive payment do receive payment - and quickly.

    Account Manager PAX
  9. It's good to see that PAX have responded, both to the original poster and here.

    I have had some professional dealings with AIG and did not find them difficult to deal with at all. They are a global company and it is unlikely that they would attempt to unreasonably decline claims for some short term gain (there are some insurers who would!).

    It would be interesting if spr5623 comes back and reports the outcome.
  10. Apologies to everyone, made a right pigs ear posting this in two forums sorry, but thanks for all the helpful comments and advice.
    I will keep you posted