‘My medical insurance claim was rejected because my insurer said I had a pre-existing medical condition’

Insurance Private Medical Insurance

We look at Sami's complaint about her claim under her private medical insurance being turned down as her insurer said her condition was pre-existing.

What happened?

Sami made a claim on her PMI policy because she’d been diagnosed with thyroid cancer. The insurer rejected the claim on the grounds that it was likely she’d had the condition before she took out the policy.

Sami’s policy excluded all pre-existing medical conditions. We asked to see the GP records and the other information the insurer had relied on when rejecting the claim. This helped us to build a timeline of events.

How we helped

We could see that Sami had been to see her GP the day before she took out the policy. During that visit Sami had said she was feeling very tired and was worried because her friend had similar symptoms and had recently been diagnosed with thyroid cancer. She also told the GP she’d used a home testing kit to check her thyroid levels and they weren’t within the normal range. We could also see that a week after she’d taken out the policy she’d gone back to her GP who had found a lump on her neck. She was referred to a consultant who made a cancer diagnosis a few weeks later.

Our decision

We explained to Sami that we thought it was most likely she was experiencing some symptoms because she decided to use the home testing kit. And we explained there was a very short period of time between her taking out the policy and the diagnosis.

We told Sami it wasn’t unreasonable for the insurer to conclude she had the condition before she took out the policy and decline her claim.