HSBC’s initial refusal to pay out in a bizarre case highlights the difficulties inherent in critical illness definitions.
HSBC is backtracking on a decision to deny a critical illness claim, highlighting the often-ludicrous definitions in the fine print of a policy.
Grenville Stanbury, 62, suffered a serious cardiac arrest and collapsed while attending a meeting of the Wadebridge chamber of commerce.
He was dead for 20 minutes before paramedics were able to re-establish a pulse. He then fell into a coma for nine days.
Five weeks later, after being fitted for a pacemaker/defibrillator, he left hospital.
But he couldn’t drive, affecting his ability to work so he made a claim on his critical illness with HSBC.
But HSBC refused to pay out because:
- The company makes a distinction between "cardiac arrest" and "heart attack." If he had suffered a heart attack, the company would have paid.
- If he had not recovered, the company would have paid up under the life insurance part of his policy.
- If he had been slightly younger, the company would have paid up. But its critical illness policy only covers patients up to the age of 60.
"When I took the policy out in 1999, survival rates for this kind of episode were much smaller, if at all, than they are today," Stanbury said to The Western Morning News.
"The policy, didn't say anything at all about a cardiac arrest as a critical illness because if you had a cardiac arrest 16 years ago, the chances were that you would be dead.
"So a cardiac arrest was not mentioned in the policy at all. It was not specifically included, nor was it mentioned as an exclusion. The policy does specify a heart attack as an example of the sort of critical illness that is covered. Most people present when the incident happened assumed I'd had a heart attack.
"I'm pursuing this with the Financial Ombudsman because I want people to know that at least one insurance company draws a distinction between these two clinical conditions, and appeared to be defying every kind of logic and common-sense in its efforts to avoid paying out.
"I was as good as dead, and if that's not a critical illness I don't know what is!"
HSBC sent a letter to Stanbury claiming its refusal to pay out was because the claim "did not meet any of the policy definitions. Our policy does not cover cardiac arrest."
But following media inquiries, the company changed its mind, issuing a statement saying, "Unfortunately Mr. Stanbury's illness is not covered in the critical illness policy he took out. But we recognise this is an exceptional case; it's a very difficult time for him and we want to help, so as a goodwill gesture we are offering the full sum of his policy."
Stanbury welcomed HSBC's change of mind but is planning to pursue his complaint to the Ombudsman because he still wants to highlight the way some insurance companies behaved.
"Naturally I am pleased that HSBC are now offering to pay the full sum of the policy but am disappointed that it has taken us nearly five months to reach this position and only then after the intervention of the media. I wonder why they did not think it was an 'exceptional case' whilst I was dealing with them myself!"
Grenville Stanbury, 62, suffered a serious cardiac arrest and collapsed while attending a meeting of the Wadebridge chamber of commerce.
He was dead for 20 minutes before paramedics were able to re-establish a pulse. He then fell into a coma for nine days.
Five weeks later, after being fitted for a pacemaker/defibrillator, he left hospital.
But he couldn’t drive, affecting his ability to work so he made a claim on his critical illness with HSBC.
But HSBC refused to pay out because:
- The company makes a distinction between "cardiac arrest" and "heart attack." If he had suffered a heart attack, the company would have paid.
- If he had not recovered, the company would have paid up under the life insurance part of his policy.
- If he had been slightly younger, the company would have paid up. But its critical illness policy only covers patients up to the age of 60.
"When I took the policy out in 1999, survival rates for this kind of episode were much smaller, if at all, than they are today," Stanbury said to The Western Morning News.
"The policy, didn't say anything at all about a cardiac arrest as a critical illness because if you had a cardiac arrest 16 years ago, the chances were that you would be dead.
"So a cardiac arrest was not mentioned in the policy at all. It was not specifically included, nor was it mentioned as an exclusion. The policy does specify a heart attack as an example of the sort of critical illness that is covered. Most people present when the incident happened assumed I'd had a heart attack.
"I'm pursuing this with the Financial Ombudsman because I want people to know that at least one insurance company draws a distinction between these two clinical conditions, and appeared to be defying every kind of logic and common-sense in its efforts to avoid paying out.
"I was as good as dead, and if that's not a critical illness I don't know what is!"
HSBC sent a letter to Stanbury claiming its refusal to pay out was because the claim "did not meet any of the policy definitions. Our policy does not cover cardiac arrest."
But following media inquiries, the company changed its mind, issuing a statement saying, "Unfortunately Mr. Stanbury's illness is not covered in the critical illness policy he took out. But we recognise this is an exceptional case; it's a very difficult time for him and we want to help, so as a goodwill gesture we are offering the full sum of his policy."
Stanbury welcomed HSBC's change of mind but is planning to pursue his complaint to the Ombudsman because he still wants to highlight the way some insurance companies behaved.
"Naturally I am pleased that HSBC are now offering to pay the full sum of the policy but am disappointed that it has taken us nearly five months to reach this position and only then after the intervention of the media. I wonder why they did not think it was an 'exceptional case' whilst I was dealing with them myself!"
