‘My wife has incurable cancer, but Aviva won’t pay out on insurance’

QLast summer my wife started having pains in her back. She was taking classes in pilates and physiotherapy to help, but the pain continued. After a disastrous attempt to be seen by the NHS, we decided to pay for a private GP consultation in January this year. She was then referred for an MRI scan of her spine.

Two days later we received a call from the GP. He informed us that the MRI scan had revealed metastatic cancer – incurable disease in her lower and middle spine. An urgent referral was made with an oncologist.

My wife and I have health insurance with Aviva, and my wife’s cover has been provided on a moratorium basis since May 20 2022, when she switched from another provider. This meant no pre- existing conditions would be covered for two years after the policy commenced.

In 2012 my wife was diagnosed with breast cancer and underwent surgery, chemotherapy and radiotherapy, before finally being declared free from any evidence of disease in July 2013. Since then she has seen her oncologist for an annual mammogram up until May 11 2018, when he decided that having been symptom- free for five years, my wife no longer needed regular check-ups. She was told she could rely on the NHS’s breast screening programme, and also continue to take a hormone drug called tamoxifen as a precaution for a further five years.

However, making a claim and dealing with Aviva has been a nightmare.

On Feb 7 I tried to contact Aviva by phone, but the only way to initiate a claim seemed to be using an online form, which I completed. There was no response, email or phone call to acknowledge the claim. The next day I looked into our portal and it was showing that no claims were registered. So I reinputted the form. Again, there was no response. My wife and I were still reeling from the diagnosis, and terrified.

I provided all the information requested to start the claim. We spoke with one of Aviva’s oncology specialists, who said that our claim might be denied. This was because the meeting my wife had with her oncologist in May 2018 apparently constituted “medical advice”, which according to the policy’s terms and conditions, excludes my wife from cover. It was also because it took place within the past five years, which the policy does not allow for.

I explained that her treatment and advice for breast cancer ceased over 10 years ago in July 2013, and that the subsequent meetings were merely preventative. There had been no new symptoms to discuss, so how could this have constituted medical advice? Aviva’s oncology expert said she would check and call back. My wife received an email from the Aviva customer team directing her to the website portal. Here, there was a message saying the claim had been refused and closed with no reasons given. It was crushing to receive such a huge blow on a screen, with no one there to answer questions. – Anon

AYour world was turned upside down with the news that your beloved wife had secondary bone cancer, which it seems has come from her original breast cancer in 2012. After more than a decade in the clear you had both believed that the “cancer chapter” was firmly behind you, however it wasn’t to be. Generally speaking, once patients pass the five-year “all clear” mark, recurrence of cancer tends to be low. But unfortunately cancer can lie dormant for long periods and rear its nasty head again at any time, as appears to have very sadly happened here.

Desperate for information, you Googled the life expectancy for your wife’s condition. The search engine suggested an average survival of six to 48 months from diagnosis, which panicked and utterly devastated you both. Feeling that each day’s delay in dealing with this claim could lead to a reduced life expectancy for your wife, you got straight in touch with me. I really felt for you, as you were both in a state of sheer panic and fear about what might lie ahead.

I asked how you came to buy this insurance with Aviva and you said you had purchased your original policy through a broker, but that you had subsequently added your wife on to it after her own separate policy with another insurer lapsed. You had simply phoned Aviva on her behalf, and after a short conversation she was added to the policy, you said. Given that your wife had a previous serious illness, I was surprised that you were able to add her to the policy with just a short phone call, and without her even being present to answer questions. You feel Aviva missold you the policy and, if you were right, I knew the answer would lie in this initial sales call, so I asked Aviva to review it, and requested to have a recording to listen to myself.

On the call Aviva’s representative explained to you the underwriting options available. The first was full medical underwriting, where you were informed that your wife would need to complete a full application form in which she would declare any pre-existing conditions. The second option was something called “moratorium” underwriting, where you were told that if there had been any symptoms, medication, diagnostic tests, treatment or advice about a condition in the past five years, your wife would need to wait two clear years from the point at which she was added to the policy before she could make a claim.

You went for the second option, which the representative accepted without question. You did not advise that your wife had previously been diagnosed with breast cancer or was still receiving medication at that time, but then you didn’t think you needed to. This was because she had been cancer-free for over 10 years and the medication she was on was a precaution and not related to any new symptoms.

I was a bit surprised that you did not question the policy cover in relation to cancer, in order to ascertain which underwriting option would be most suitable and whether cover would be provided, however I don’t think you deliberately intended to conceal anything from Aviva. In your mind the cancer was way in the past, and your wife was now fit and well. I also think Aviva was at fault for not asking directly whether there was any significant medical history. You also feel the terms and conditions should have been made clearer in the phone call, and although I agree, Aviva said that the key terms and conditions were sent through to you afterwards, meaning you had an opportunity to read them and double check the cover was suitable.

Your terms and conditions on the policy state that it will cover pre-existing conditions if you do not have: medication for, diagnostic tests for, treatment for, or advice about, that condition during a continuous twoyear period after you join the policy. In your case this was May 30 2022 to May 30 2024. However, because your wife was taking anti- cancer medication and had check-ups with a consultant during this time, I’m so sorry to say that Aviva is still not prepared to pay out on the policy. This isn’t the answer you were hoping for, I know. Had you bought the policy through an experienced broker, I don’t think you would have slipped through the net like this as you would have ended up filling out the forms, which would have revealed the medication and appointments. Your case is a warning shot to anyone buying health insurance with any significant medical history: you must mention everything and anything, even if it doesn’t seem relevant.

Am Aviva spokesman said: “We are extremely sympathetic to the circumstances affecting our customer. We have carried out a detailed and thorough review of all the information including the latest medical information and, regrettably, we are unable to accept a claim.” However, it accepted the service you received when trying to make a claim was utterly woeful, and added to your trauma. It has offered you £500 compensation for this, but you say you want this donated directly to a cancer charity. You’ve also taken your case up with the Financial Ombudsman, a decision I support.

In better news, your wife has now heard that her prognosis is much better than you originally feared, and she is now receiving the treatment she needs. I hope it’s as successful as can be hoped for at this stage.