Insurance Nightmare: Aviva Leaves Family in Despair After Long Delay in Aid for Ill Child

Our 16-year-old son suffers from an incurable degenerative condition, requiring constant care, which has led my husband to quit his job. However, Aviva denied our claim under the critical illness policy.

Since 2007, we have been paying a monthly premium of £60 for this insurance.

He was born in 2008 and at the age of eight, he was diagnosed with spinal muscular atrophy with respiratory distress (SMA-RD).

He attended a mainstream school successfully until last June when his condition worsened significantly, leading to paralysis in all limbs.

In January, we reached out to Aviva to start our claim process. We were shuffled between three different departments and endured a wait of over three and a half hours. An adviser insisted he wasn’t eligible but failed to clarify the eligibility criteria.

We requested our policy documents twice, yet never received them. We lodged a formal complaint regarding their poor communication in February, and our doctor provided medical reports.

By the end of June, they had rejected our claim. They argued that since SMA-RD is genetic and present since birth, it wasn’t covered as his policy started when he was one year old.

This might explain why Aviva reported a £1 billion operating profit in the first half of this year.

NL, Belfast

Insurance companies often view human distress through the prism of clauses and financial implications. They are businesses, after all. However, this doesn’t mean they should lack compassion, which Aviva clearly did in your case.

Despite the urgency of your situation, it took them five months to make a decision. The emails you sent me show your repeated requests for updates.

Your policy does automatically include children after their first birthday. Indeed, the terms state that conditions present from birth aren’t covered and that symptoms mustn’t have started before the coverage began.

You sought advice when your son was one because he wasn’t hitting certain developmental milestones, but all tests were negative. It wasn’t until seven years later that he was diagnosed with SMA-RD.

The Financial Ombudsman Service usually supports complaints about denied claims due to undisclosed pre-existing conditions.

They also tend to disregard exclusions in insurance policies if the symptoms at the start of coverage were general and couldn’t have reasonably been expected to lead to a claim later on.

Missing general developmental milestones at one year could be due to many reasons, not necessarily incurable diseases. I argued to Aviva that you couldn’t have known your son had a serious condition that would result in a claim 15 years later. Their rejection based on a technicality seemed unreasonable, given the complexities and timeline.

Aviva’s response was surprisingly swift. Within two days, they informed you that although they still believed the claim didn’t meet their policy terms, they would pay the full £10,000 covered by your policy. They admitted that my involvement had prompted this decision. The payment was processed quickly into your account.

Aviva stated, “We fully acknowledge that our service and communication fell short of what our customers expect. The family’s situation warranted a faster and more compassionate response.

“While we are unable to approve NL’s son’s claim based on the policy terms, we recognize the unique circumstances and our service shortcomings, and feel it is right to offer a goodwill payment equal to the benefit that would have been paid had the claim been eligible.”

Raising the Bar

Many companies generally perform well. When they don’t, they often correct their mistakes. Some even exceed expectations in a way that deserves recognition.

“I own a £73 pair of Cocoons sunglasses that fit over regular glasses,” shares LR from Colchester. “I have macular degeneration, and UV protection helps slow its progression. My puppy scratched the lenses. When I called to ask if this affected the UV protection, I was told that under the warranty terms, I could get a new pair for just £2.99 postage.

“I mentioned that a four-month-old German shepherd doesn’t quite qualify as ‘normal wear and tear,’ yet they sent a new pair anyway.”

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