Life insurance company refuses to pay claim for dying former serviceman

Posted Mar 18, 2019.
A former Royal Navy submariner has had a claim under his life insurance policy refused by his insurer, despite him being unlikely to live more than another 12 months.  

47 year old Paul Webb was diagnosed with interstitial lung disease in 2018 and was originally told by medical experts that he had between two to three years to live. However, his condition has declined to the extent that the ex-serviceman and father of one is now not expected to live longer than twelve months. 

Since 2015, Mr Webb has been paying £20 per month for life insurance cover that should, under the terms of the policy, pay a sum of just over £200k in the event of his death or should he be diagnosed with a terminal illness where life expectancy is likely to be less than twelve months.  Such a pay out would mean that Mr Webb could work less hours and spend more time with his young son; however, Legal & General has refused to pay because they claim that should he have a lung transplant, then he could live longer. Whilst Mr Webb is on the lung transplant list, with over 300 other individuals also on the list, it is uncertain that he will live long enough to actually receive a transplant. Following his claim, Legal & General wrote to Mr Webb, saying 

“We do not dispute the severity of your illness. However, the opinion of the doctors who are treating you suggests that initially life expectancy was one to two years without a lung transplant and you were prioritised for an early lung transplant…while we recognise not everyone on a transplant waiting list will be successful, we have to consider that there is a potential for a transplant. 'Therefore the doctors who are treating you, our medical officer and the third medical expert are all unable to confirm a definite life expectancy prognosis of less than 12 months at this time."

Disputed claim contested

An investigation by Money Mail has highlighted the frequency with which large UK insurance companies (Legal & General made over £2 billion in profit in 2018) have repeatedly been criticised and admonished by the Financial Ombudsman for incorrectly refusing legitimate claims. Since 2013, the Ombudsman has overturned more than 150 such ‘claim refused’ initial decisions by insurance companies.  Following the investigation and further intervention into the disputed claim, Legal & General eventually agreed to pay Mr Webb. He commented:

“It (his claim) has been handled in a disgusting way…I feel that Legal & General was using the lung transplant as a get-out clause. Three months when you've only got twelve is a long time and patients should never be treated like this”

Commenting on the disputed claim, a Legal & General spokesman said: 

"If a customer is on a waiting list that will extend their life beyond 12 months, the circumstances would not usually meet the terms of our policy definition…if the treating specialist and our medical officer agree an individual's condition is changing, they may agree a life expectancy of less than 12 months."

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