Our client had a critical illness policy covering pre existing conditions providing he had been free of all symptoms for a period of at least 2 years prior to the reoccurrence. It was also stipulated that no medical consultation was to have taken place about the pre existing condition.
The policy was declined on the basis that our client had undertaken regular appointments with his Doctor in respect of the pre existing condition and as such the Insurance Company insisted that our client’s claim was excluded under the policy.
We successfully argued the appointments did not constitute a consultation.
Our client was delighted, as were we, that the Financial Ombudsman agreed with our interpretation of the terms and conditions and as such upheld our complaint and the Insurance Company were ordered to honour the claim.