Facing Challenges with Aviva
Our son, who is just 16, has been diagnosed with an incurable degenerative disease. He now requires round-the-clock care. My husband had to leave his job to take care of him, but Aviva seems unwilling to support us under their serious illness policy.
Since 2007, I have been paying £60 a month for this coverage.
Our son was born in 2008, and I received a diagnosis for spine muscle atrophy with breathing difficulties (SMA-RD) when he was eight years old.
Up until June of last year, he was managing well in mainstream schools, but his health has since worsened, resulting in paralysis in all four limbs.
I reached out to Aviva in January to query our eligibility for financial assistance. We were shuffled between three departments and ended up waiting over three and a half hours. The advisor said he didn’t qualify but didn’t clarify the criteria.
I’ve asked for a copy of the policy document twice but haven’t received it. In February, I lodged a formal complaint about their lack of communication. Our consultant submitted a medical report to support our case.
By late June, our claim was denied. The rationale was that SMA-RD is a genetic condition that would’ve been present at birth, while our policy coverage only kicked in on his first birthday.
It seems like Aviva might be prioritizing profit—after all, they reported £100 million in operating profit for the first half of this year.
Insurance companies often view human suffering through a lens of terms and profits, which is understandable to some extent. Yet, business should not exclude compassion, and it certainly felt lacking in our dealings with Aviva.
It’s frustrating that, despite the urgency of our situation, it took them five months to arrive at a decision. The emails I sent showed my repeated requests for updates.
According to their serious illness policy, coverage starts when your child turns one. If a condition is present at birth, it isn’t covered, and symptoms cannot appear when coverage begins.
I sought advice because our son hadn’t met a certain developmental milestone, but all tests returned as negative. It took seven more years for him to be diagnosed with SMA-RD.
The Financial Ombudsman Service usually supports complaints regarding claims denied due to terms that customers aren’t aware of.
They also note that if symptoms were merely general when the coverage began, that could invalidate the insurer’s terms and would not predict a later claim.
There are various reasons a one-year-old might miss developmental milestones, and they’re often not related to critical diseases. I shared with Aviva that there was likely no way to know that my toddler had severe conditions that would lead to a claim 15 years later. Given the complexity of the situation, it could be seen as unfair to deny any claims.
Surprisingly, Aviva responded quickly. Within two days, they informed me that they still believed our claim didn’t meet the criteria, but they would pay the £10,000 allowed by our policy. Honestly, I was somewhat encouraged by their change of tone. Before I knew it, the money was in our account.
They acknowledged in their communications that they fell short of what customers rightfully expect, and that the family’s situation should have prompted a more compassionate response.
While they still cannot approve our son’s claims due to policy terms, they recognized the particular circumstances of this case and deemed it fitting to provide a goodwill payment, reflecting the benefits that the family was entitled to receive.
