CommInsure challenged over trauma claim
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A Financial Wisdom adviser is challenging CommInsure over its rejection of his trauma claim.
Brian Handley is a Financial Wisdom adviser and the claimant in the case, which is currently before the Financial Ombudsman Service.
Handley’s trauma policy claim, after he was diagnosed with prostate cancer last year, was rejected on a basis which Handley claims highlights potential dangers for other policy holders — including his clients.
The argument between Handley and CommInsure focuses on the use of the word ‘requires’ in relation to the treatment of cancer.
Handley’s policy states he will be paid “following the diagnosis of the life insured suffering one of the specified events nominated below”. It later defines cancer as “any malignant tumour characterised by the uncontrolled growth and spread of malignant cells that requires treatment by surgery, radiotherapy, chemotherapy, biological response modifiers or any other major interventionist treatment”.
While surgery is available to him, Handley, with a T1C cancer and a Gleason level of six, has elected active surveillance of his condition until treatment becomes non-elective.
CommInsure rejected the claim on the basis that Handley does not “require” treatment at this stage.
Handley said his specialist was faced with the dilemma of patients being “influenced by their trauma policy and having [surgery] when, in his view, they shouldn’t move that quickly” in order to effect a payment.
Handley said it was not made clear that the word “requires” constitutes mandatory treatment.
“They have not done this in the [Product Disclosure Statement], the policy contract or in adviser product training,” Handley said.
“Had it been presented that way, I would not have sold this policy to myself and certainly not to a client, based on a product comparison with ING or AXA who require the diagnosis of condition only.”
Handley pursued CommInsure over the definition of the word ‘requires’, in particular querying whether a claim would be denied if a client with breast cancer elected alternative medicine or none at all. He said this raised the broader issue of a patient’s right to choose.
Handley said CommInsure had verbally confirmed treatment is required to trigger a payment. However, a recent email from CommInsure to the FOS states there is “no requirement for the person to agree to treatment”, but that the state of the cancer “requires the treatment”.
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