SALLY SORTS IT: Insurer won’t pay £36k claim after my cardiac arrest

I suffered a cardiac arrest in October 2020 and tried to make a claim on my critical illness insurance with Royal London. The claim was refused.

I contacted the Financial Ombudsman Service but didn’t proceed as I wanted to put events behind me and move on with my life. Unfortunately, two weeks before Christmas 2022, I suffered another cardiac arrest and spent two days in hospital.

I had thought the original incident was just a blip which I was very lucky to survive but now I accept that this will be something I have to live with.

While I was laid up, I saw your article on December 28 in which you helped a fellow cardiac arrest survivor successfully make a claim on his critical illness insurance with Royal London.

My experience is similar, and I wondered if you could help me. I have had a policy with Royal London since 2006 with a critical illness benefit of £36,258. Any assistance would be greatly appreciated.

Anon.

Declined: Insurer Royal London refused to pay out on a reader’s critical illness insurance policy after she suffered a cardiac arrest

Sally Hamilton replies: To recap on the cardiac arrest case, referred to in your letter, the policyholder I helped was initially told he could not claim on his critical illness insurance because this type of health incident was excluded from his policy.

But, after my intervention, Royal London investigated his case fully and agreed to pay him the full cover of £244,000, by taking additional aspects of his health condition into account.

Cardiac arrest is a typical exclusion in old-style critical illness policies because, to put it bluntly, few people survived such incidents in the past. Cardiac arrest is when the heart stops pumping blood around the body, usually triggered by an irregular heart rhythm.

With heart attacks (which are usually covered) the chances of pulling through were far greater and policyholders would benefit from the financial cushion of a pay-out. 

Heart attack means the death of a portion of the heart muscle, typically due to a blockage, a clot or narrowing of the arteries.

However, medical advances mean the chances of surviving a cardiac arrest are greater today. As a result some more modern critical illness plans than yours now include cover for these episodes, so long as they are serious enough to need an implant as part of the treatment.

As happened with the first case I investigated, you were put off from proceeding with an official claim in 2020, beyond the initial enquiry made to Royal London, as the call handler had told you cardiac arrest was not covered.

After contacting me, you wrote to Royal London quoting my article and asked the company to look at your case again. 

At the same time, I made a similar request, and the insurer agreed to take a closer look at your case to check if anything had been missed, so long as you submitted a full claim.

This you quickly did, with the help of your wife. As you were still poorly, I checked in with her, and with Royal London over the weeks and months that followed, with the insurer confirming that investigations were continuing.

As with any medical related insurance claim, it can take an age to reach a conclusion, with letters and documents going to and fro, between policyholders, doctors, claims handlers and in-house medical experts.

But finally, more than five months after I set the ball in motion, Royal London came back to me with some excellent news. It had decided to pay your claim after all.

Royal London said that while cardiac arrest may not have been covered, the fact that you were unconscious and unresponsive following the original incident meant your claim could be considered under the policy’s coma definition, which is covered.

A Royal London spokesman says: ‘Having considered all of the medical evidence and reviewed the case with our consultant medical officer, we will pay the full sum assured. 

‘The case is a complex one that didn’t definitively meet any of the definitions covered by his policy. 

‘Cardiac arrest is not one of the defined events covered in his policy and our claims assessors, in consultation with our medical officers, found no evidence in this instance to allow the claim to be paid under the heart attack definition. We also examined the evidence to see if the coma definition was met.

‘While it isn’t clear-cut that the policy definition of coma is satisfied, we recognise the significance of the event he suffered and taking into account all of the overall circumstances, we’ve concluded that sufficient elements of the coma definition are satisfied to warrant making a payment.

‘The decision is in line with Royal London’s aims to pay as many claims as possible and the amount of £36,258 will be paid.’

Your wife told me you were both very pleased with the outcome.

DVLA scrapped granddaughter’s number plate 

In 2014 I bought my granddaughter a personalised registration plate from the Driver and Vehicle Licensing Agency (DVLA) for £799 to keep and give to her for her 17th birthday in 2027. 

I put the paperwork in a drawer for safe keeping.

In 2020, I read in the Press that unless ‘cherished’ numbers like mine, held on retention, were re-registered, then they could be lost. 

But when I tried to re-register the plate, I found out that there was a problem. 

Because I hadn’t made a one-off payment of about £25 — which I knew nothing about — DVLA had scrapped the number.

I’ve tried appealing but to no avail. I’ve been thinking about it again recently and wondered if you can help because it seems totally unfair.

G.R., Newcastle-upon-Tyne

Sally Hamilton replies: You were pleased with yourself at finding the number plate YV13 JAY, based on your granddaughter’s name, to present as a special gift, albeit many years in the future. 

You explained to me that on receiving the documentation by post you could see the correct registration number through the envelope’s window, so left it unopened and filed it away.

This proved to be a big mistake. If you had opened the letter, it would have revealed that the document — a V750 Certificate of Entitlement — had an expiry date and that you would need to re-register the personalised number after 12 months and pay a £25 fee.

Your timing was unlucky in this respect, as a year after you made your purchase in 2014, the DVLA rules changed. 

From 2015, buyers of personalised plates (also known as cherished number plates) for future use only needed to renew the certificate after ten years, if the number had still not been assigned to a vehicle.

I asked DVLA to check whether anything had been overlooked in your case but I’m afraid it confirmed that there was nothing it could do because you had not made the appropriate payment.

A DVLA spokesman says: ‘As per standard procedure, DVLA correctly issued the customer with a V750 Certificate of Entitlement which included the expiry date. 

As a courtesy service, DVLA also issues reminders three to four weeks before the expiry date to remind customers of the retention fee payment, which was issued in this case.’

You told me you never received the reminder from DVLA. With this in mind, I asked whether, as a goodwill gesture, DVLA might consider issuing you a similar registration number in place of the one that was lost. 

After all, it had taken payment for the original number. I’m afraid to say that DVLA declined.

For people who hold a personalised registration, whether it is for their own use later, or as an investment or a gift for someone else, it is vital to check the expiry date to avoid the same loss and disappointment. 

To sum up, registration numbers bought before March 9, 2015, were typically valid for 12 months and required renewing each year for a fee.

Purchases made since March 2015 come with a certificate with a ten-year expiry date, after which holders must renew, if it has not been transferred to a vehicle. Unfortunately, if a certificate has expired, then so does the registration number, as happened with you.

I’m sorry to be the bearer of this bad news. Yours was an expensive lesson to learn that it is vital to read important documents received in the post before filing them away.

• Write to Sally Hamilton at Sally Sorts It, Money Mail, Northcliffe House, 2 Derry Street, London W8 5TT or email [email protected] — include phone number, address and a note addressed to the offending organisation giving them permission to talk to Sally Hamilton. Please do not send original documents as we cannot take responsibility for them. No legal responsibility can be accepted by the Daily Mail for answers given. 

This post first appeared on Dailymail.co.uk