The insurer says I’m not really sick and won’t pay my income protection insurance claim…what can I do?

The insurer says I’m not really sick and won’t pay my income protection insurance claim…what can I do?

Income protection insurance

Generally (unless it is specifically excluded), income protection insurance should cover mental illness in the same way as other health conditions. However, we are seeing an increasing number of insurance claims for mental illness being declined on very dubious grounds.

This can be incredibly stressful at a time when you already have more than enough stress. We know how incredibly difficult this can be, but it is crucial that you don’t just give up on your claim.

Income protection insurance can provide you with the financial security you need to give you the space to properly deal with and learn to effectively manage/recover from your mental illness.

These are some things that can be helpful to do if an insurer declines your claim.

Read and understand in detail what is covered under your policy

An important thing to look at is how “disability” or “incapacity” is defined. Different levels of cover have different tests for how sick you need to be before the policy will pay out.

Normally there are four levels of cover:

  • own occupation“. This is the top level of cover. This means that you are covered if you can’t do the particular occupation that you were performing when you became unwell. For example, a solicitor is covered if they are unable to perform the role of solicitor, even though they may be able to perform a less demanding role in another type of employment.
  • any suited occupation“. This provides cover when you are unable to work in your own occupation or an occupation which your education, training or experience suits you. For example, a solicitor may be unable to practice in a corporate law firm but may be able to lecture or teach.
  • any occupation“. This provides cover only if you can’t work in any occupation at all. So for example, if a solicitor is unable to work in the legal field at all but is able to work as a cashier in a supermarket, they are likely not covered by the policy.
  • totally disabled“. This provides cover only if you can’t work at all.

It is important to understand what test the insurer is applying when it claims that you are not too sick to work.

Collect and review your medical evidence 

It is very helpful to collect together all the medical evidence about your illness. This can include your GP records (which you can ask for a full copy of for a small charge) and records of treatment you might have received from other specialists such as Psychiatrists or Psychologists.

Consider if your records properly describe your mental illness? People with mental illness are often ashamed and embarrassed and it is common to downplay their condition when describing it, even to medical and mental health professionals.

Consider if the insurer has been provided with all the relevant records which support your claim to your illness?

Make a formal complaint to the insurer

The first step is to go through the insurer’s official formal complaints process. You should set out why you think your illness meets the criteria in the policy and what you would like the outcome of the complaint to be.

Insurers have an obligation to consider all complaints within eight weeks.

If the insurer rejects your complaint or doesn’t deal with it properly you have two main options

If the insurer rejects your complaint or doesn’t deal with it properly within eight weeks you have two main options – you can go to the Financial Ombudsman Service or you can go to court. In almost all cases it is going to be easier and more cost effective to go the Financial Ombudsman Service.

We understand that all of these things that we have suggested can be challenging at the best of times and when your mental health is compromised cognitive tasks like this can simply be too much. At Bilantia can support you through this process.

Becks Depression Inventory

If you are currently having problems with income protection insurance please reach out and see if we can help you. Call us on 0798 480 5351 or email us at info@bilantia.com. We have consulting rooms in London and Brighton and can consult online to anywhere in the world. Click here to see some of the ways in which we can help you.

Nicole Shinnick is the Founder, Managing Director and a Lead Consultant at Bilantia. Before founding Bilantia, she spent six years as a Senior Ombudsman at the Financial Ombudsman Service making legally binding decisions on insurance disputes.