My £7,300 Aviva care cover won’t pay out now I need help around home

Dear Sally

TWENTY years ago, at the age of 70, I took out a PPP Health Care policy to cover the cost of care if I ever needed it. I paid a single premium of £7,321. The policy, which was later taken over by Aviva, is now worth £1,675 a month towards the cost of care.

In recent months, I’ve had to start employing carers. Last summer, I needed a hip replacement after a fall and I’ve had mobility problems ever since.

I also suffer from Parkinsonism. My wife helps me get showered and dressed but she’s 88 and not in good health. She gets very tired so we need extra support.

Naturally, I thought I could use my Aviva policy to meet some of the cost, but it refuses to pay out. R. M., Edinburgh.

The rising cost of long-term care is an emotive subject — and many people worry about how they will meet the vast bills should they need to. The average cost of a residential or nursing home can exceed £50,000 a year. At-home care can be just as expensive, depending on how often carers visit or whether they are live-in.

These cost issues were a concern for you two decades ago, so you decided to purchase an insurance policy you could rely on if you needed care in later life. under the terms of the policy, Aviva agreed to meet the costs of care if you ever needed it, in return for the lump sum you paid.

When you made the claim on your policy last year, Aviva agreed to pay £5,000 for equipment that might help in your flat. You were grateful but haven’t yet taken the firm up on the offer. however, it refused to pay you an income to cover the cost of the at-home care you need.

It said that, to qualify, you need to fail at three activities of daily living. These include moving from room to room; washing and bathing; putting clothes on and off; feeding yourself with pre-prepared food and drink; and transferring yourself (for example, to a toilet or from a chair to a bed).

Apparently, walking unsteadily with two sticks and requiring help with dressing, washing and meal preparation wasn’t enough to trigger the payment.

You felt aggrieved because the policy had not spelt out that you needed to fail three activities to qualify — it simply said you had to be unable to do a number of them. You told me you only cope because your wife helps.

I asked Aviva to double check your assessment. A few weeks later, Aviva decided to meet your claim after all.

It said your mobility issues may be more of a problem than it had initially thought.

An Aviva spokesman says:

‘ We reviewed additional information provided to us, taking into consideration his overall situation and the risk that he faces with his mobility. We are always happy to review any decision made on claims if a customer provides additional information.’

A monthly payment of £1,675 has been authorised, along with £11,348 in payments backdated to october. You tell me you are mightily relieved. These plans no longer exist for new buyers as insurers deemed them too expensive to run, and demand was never that high.

right now, if you want a policy to ‘insure’ you against the costs of care, the best equivalent is an ‘immediate needs annuity’, guaranteeing a fixed income for life in return for a (hefty) lump sum. The monthly income is tax-free, as long as it is paid directly to a care provider.

With the help of a financial adviser, I organised such a scheme for my late mother a decade ago. The care annuity would cover half her care-home bills — which were about £1,000 a week — and she would pay the rest using her pensions and dividend income.

she lived in the home for six years before her death, and the annuity broke even. had she died within a year of entering care, say, it would have been an expensive purchase. But that was a risk we were prepared to take so that she and the family didn’t have to worry about her funds running out.

Those without your type of insurance can get support from the Government if they meet certain criteria.

In england, if you have savings of £23,250 or more, you will not qualify for help. There is some assistance for those with savings between £14,250 and £23,250, and maximum support for those with less than £14,250. The equivalent capital limits for residential care in scotland are £20,250 for the lower and £32,750 for the upper.

In Wales, the thresholds are £24,000 for non-residential care and £50,000 for residential care. Those living in Northern Ireland who have more than £23,250 in assets must meet the full cost of residential care themselves.

In scotland, all assets are ignored for those who require care at home, though they must have first passed the strict health eligibility criteria.

You say that you will now investigate what help you might be able to get from the Government as a resident of scotland.

The Government has promised to introduce a cap (in england) of £86,000 on the total amount an individual can contribute to their care from october 2025.

however, this will only cover the nursing and assistance part of fees. other elements such as accommodation, food and energy bills will still have to be met by the individual.

Find out more at paying forcare.org. For the rules in scotland, go to advice.scot. For Wales, visit gov.wales, and in Northern Ireland see nidirect. gov.uk. Anyone who does not qualify for help and needs to pay for care right away may have to sell their home or make an arrangement with their local authority to defer the fees and repay them later, perhaps from their estate after death.

They can also raise cash by using an equity release loan.

I BOOKED flights for my wife and I to the Dominican Republic in December with TUI, at a cost of £2,068.

But the university where I work as a professor is making me redundant, so we can no longer afford the trip. I emailed TUI’s ‘exceptions’ department to get a refund but never received a reply.

G. K, Wolverhampton.

THOUGH it is not obliged to refund you under its usual terms and conditions, TUI does consider exceptional circumstances. Though the exceptions department failed to acknowledge your pleas for a refund, I’m pleased to say that once I intervened to explain your position, it quickly offered you your money back.

A TUI spokesman says: ‘We were sad to hear about G. K.’s situation. We have now spoken with him and found a solution that he is happy with.’

Would-be travellers in a similar situation who aren’t refunded by their tour company might be able to claim on their holiday insurance instead, so long as unexpected job loss is covered. The insurer will usually need a confirmation of the redundancy from the employer.