Doctors say Violeta is dying -- yet Legal & General refused to pay £130k life cover claim
VIOLETA BEAVER has less than six months left to live.
This is written down in black and white in a letter from her cancer specialist.
Yet insurance giant Legal & General claimed it knew different, as its medical experts — who had never met Violeta — said she might live longer.
And until the company was satisfied the 63‑year‑old would not survive for longer than 12 months, it would not pay out the £130,000 she was owed under the terminal illness clause of her life insurance policy.
Just when she needed her insurer most, Violeta was left without the funds to fly relatives to the UK for a final visit.
Her case is a harrowing example of how insur‑ ance firms are able to wriggle out of terminal ill‑ ness claims by declaring that they know better than specialist consultants.
Britain’s complaints watchdog says it will not tolerate this type of behaviour.
The Financial Ombudsman has repeatedly told insurers they must have an exceptionally good reason for overruling the medical opinions of a customer’s own doctor.
Yet Money Mail continues to hear distressing cases of insurers ignoring this and using the judgement of anonymous medical experts, hired to save money on claims.
We can reveal that the back‑office staff who determine whether you receive a payout for cancer or heart disease are often no more quali‑ fied than a family GP.
And because insurers do not have to refer every case to a medical professional, they some‑ times let unqualified ‘claims handlers’ make the life‑changing decisions.
It was only after a week of repeated telephone calls and emails from Money Mail that Legal & General backed down. It agreed to pay Violeta’s claim just 48 hours before we went to press.
A swift settlement was crucial because every day L&G dragged its feet, Violeta and her husband Perry were losing money. They have what’s known as a decreasing‑term life insurance policy, which means their cover reduces every month.
Had Legal & General paid out when the couple first claimed in January they would have received £131,536. If the claim had been strung out until March they’d have got just £130,381 — a £1,155 less.
Perry, 56, from Surrey, says: ‘My wife is dying. We want to enjoy the time we have left and fly her brothers over from the Philippines, where they live, to see her.
‘You can’t imagine what it’s like to keep saying, “My wife has less than six months to live” over and over again on the phone while she can hear. I then have to come off and try to be positive and encourage her to fight and beat the odds. I just can’t believe their attitude.’
Violeta, a nurse for 40 years, has been battling breast cancer since 2012. She had a lump removed from her right breast that December, followed by a course of chemotherapy and radiotherapy.
But in December 2014 a scan revealed the cancer had spread to the lymph nodes under her right arm. She had major surgery to remove these, more chemotherapy and more radiotherapy.
Last November the couple were hit with more bad news. The cancer had spread again. This time she needed a lump removed from her neck. Scans also revealed tumours in her lungs, ribs, spine and brain.
Violeta’s cancer is terminal. She is currently taking chemotherapy in tablet form and waiting to see if brain surgery is an option. But any treat‑ ment cannot cure her — only attempt to prolong her life.
The diagnosis is just the kind of utterly unexpected and devastating event life insurance is designed for.
The Beavers, who have two sons in their 30s, have paid into a joint life insurance policy with Legal & Gen‑ eral since 2005. This would pay out a lump sum should one of them die or get a terminal illness. In 2010 they’d increased their cover to ensure the payout would be enough to clear their mortgage. They pay premiums of £122 a month.
When they first made the claim Legal & General said it accepted Violeta’s condition was terminal but would not pay out as, in its own experts’ opinion, Violeta could still live longer than 12 months. She was still receiving treatment The couple complained to the Ombudsman, who fast‑tracked the case. But the couple were worried Violeta could die before they received a penny and so contacted Money Mail.
Perry, who shut the garage he ran last year to care for his wife, says: ‘If I was making a claim for a car accident I wouldn’t mind waiting a year or two for it to be sorted out, but we’re running out of time.
‘We were just desperate for this to be sorted. It’s been exhausting. We need all our energy to fight for as long as we can get together. I’ve been with Violeta since I was 16 years old. I can’t believe Legal & General wrangled over a few months.’
To claim a terminal illness payout, insurers typically state in their small print that you must have less than 12 months to live.
But predicting when someone will die is an imperfect science. Doctors rely on averages and usually avoid specifying a number of months; this is both risky and detrimental to anyone fighting for their life. So when a doctor says a patient has less than six months left — as Violeta’s did — it is a big step.
An Ombudsman spokesman says: ‘A patient’s prognosis is rarely clear‑ cut. We expect insurers to act in the spirit of a contract and not look for reasons to avoid paying out.
‘ Terminal illness cases are tremendously sensitive and no insurer should look to drag out the process of paying a claim.’
There are no set rules on how an insurance firm must deal with a claim. Medical experts who review a case must be GPs. Insurers typically have a more qualified chief medical officer who oversees proceedings.
Firms say they are cleaning up their act and pay out nine in ten terminal illness claims, but it is no consolation to Violeta and Perry.
An Association of British Insurers spokesman says: ‘Insurers regularly review their practices to ensure they take account of medical developments.’
A spokesperson for Legal & General said: ‘We have been doing everything we can to help Mr and Mrs Beaver in what are very difficult circumstances. We have now received the most recent medical information that we required and have been able to settle the claim.’