Aviva won’t pay £50,000 claim because I had a cardiac arrest... not heart attack

I SUFFERED a cardiac arrest in November last year, but insurer Aviva says I am not eligible for a payout under my £50,000 critical illness policy because it covers only heart attacks and not cardiac arrest.

I’d always thought they were one and the same. Since then, I’ve been led a merry dance by the insurer. Please can you help? r. G., Surrey. yOU described to me with remarkable calmness the terrifying events of last November — although you said your wife had to explain them to you as you have no memory of what happened that day.

you woke up with flu-like symptoms and, after first consulting your brother-in-law, a GP, you took his advice to visit your own doctor. He took your pulse, which was racing at 300 beats a minute, when a normal rate is between 60 and 80.

you were dispatched to a&E where, soon after arriving, you suffered a cardiac arrest and were out for about 12 minutes before being resuscitated. you spent ten days in a coma and on multi-organ support, and were not expected to survive.

Even when you unexpectedly regained consciousness, your wife and daughter were told that you may have suffered permanent brain damage and could need a wheelchair.

as the weeks passed, this frightening prognosis, thankfully, did not come to pass and, after a month in intensive care, you were discharged on December 27 — returning home without the aid of a wheelchair.

While you may have emerged in a far better state than predicted, your heart is still too weak — and always will be — to enable you to return full-time to your occupation as a selfemployed carpet and oven cleaner.

aged 55, you were naturally worried about how this would affect your family finances.

you believed that the critical illness policy you set up in 2001 with Norwich Union (now aviva) would be a financial lifeline.

But your claim for cardiac arrest was rejected twice — first after your wife had called aviva while you were in a coma.

Sadly, older policies such as yours normally cover heart attack but exclude cardiac arrest. Few people, other than those in the medical profession, understand the difference. Cardiac arrest is when the heart stops pumping blood around the body, normally due to an irregular heart rhythm (as happened to you). Heart attack is when a portion of the heart muscle dies, perhaps due to a blockage, a clot or narrowing of the arteries.

Cardiac arrest is now covered as standard in many more modern critical illness policies. Even aviva has included it for many years.

It was excluded from older plans because, to put it plainly, people rarely survived cardiac arrest.

Life insurance was, therefore, the relevant policy. Medical advances mean victims are now more likely to pull through.

When you were knocked back a second time over a cardiac arrest claim, aviva did suggest you might qualify under total permanent disability — but that couldn’t be determined yet as the insurer said your condition could change.

you were flabbergasted, as your heart is now functioning at about 35 per cent of its full capacity and you have been told it will never return to normal. you have also been fitted with an implantable cardioverter-defibrillator — a type of pacemaker that helps to control your heart’s rhythm.

It was then that you came to me for help. I have investigated two similar cases involving the denial of cardiac arrest claims and, after requesting the insurers reopen the claims, they were able to find a way to pay.

With your case, I was instantly struck by the references to coma, a condition that I thought should trigger a payout. armed with this argument, and other details you had given me about your incident, I asked aviva to look again.

It took just days for the insurer to confirm it would pay after all — under the coma definition. your £50,000 payout was swiftly transferred to your bank account, with £750 added as an apology for the poor service you had received.

you were delighted and said the money would enable you to repay friends you borrowed money from after the incident. It will also give you the breathing space to focus on further recovery before (hopefully) returning to your job. Carpet cleaning won’t be possible because of the heavy equipment involved, but you hope to get back to oven cleaning part-time.

an aviva spokesman says: ‘ We are very sorry that our customer has not received the claims experience that he should have done. On reviewing the case, and in light of new information made available to us, we are able to pay a claim under the coma definition on the policy.

‘We always look to pay as many claims as possible, and while the policy did not cover cardiac arrest, we regret that we did not fully explore whether he met the coma definition during our initial discussions with him.’

aviva said it will take steps to improve the claims process as a result of your experience.

I sincerely hope other insurers learn from your tale and wake up to the importance of gathering full facts at the start of a process so that customers’ claims are not batted away without being given proper consideration.

ON OCTOBER 9 last year, while doing my usual online grocery shop with Asda, I ordered two Nintendo games costing £40 each for my grandson’s Christmas present. I immediately wrapped them and put them aside. Come Christmas Day, my grandson opened the parcels only to find dummy cases containing no games. This caused great upset.

I contacted Asda numerous times but it did not offer a refund. I was told to return the cases to the store, which I did, but again I received no refund.

The online grocery manager then promised a refund and a £20 goodwill voucher — but nothing materialised. Now I have no goods and no refund. Please help.

K. e., yeovil, Somerset. I rECaLL the dismay, when I was a youngster, of receiving a batterypowered toy for Christmas that came without any batteries. So, I can imagine your grandson’s disappointment on opening the empty games boxes.

I asked asda to put things right as you’d waited far too many weeks for redress. asda investigated and, I am pleased to say, swiftly apologised, refunded your £80 and sent you a £20 voucher for the inconvenience.

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