# Commbined Insurance not willing to pay Claim



## dymo (5 Oct 2010)

I have A sickness policy with combined for the last 5+ years and this is my first time in claiming form them.I am self employed but for the last number of months i have been out of work due to chronic sinicus i have been on tablets and am also waithing on a operation but as my chest has been too week they have this put off for another few week.

I put in my claim to combined and after a number of moths of nothing from them i am after resciving a letter from them stating that the belive my losess are excessive and they are olny willing to pay out for 24 days wich comes to €500.They have never asked that i be seen by an independent doctor or have never asked to see my xrays or anything i have also asked to speak to my customer respensive but all i hear is that they are in training.

I know in this day and age they do have to be careful but i have been paying my policy and i have been out of work due to sickness.

Where do i go from here.My payment is due to go out on the 13 of this month and i do not know what to do as i feel there is no point in paying for something that is of no benfit to me.


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## Deas (5 Oct 2010)

Have you looked on the other threads about combined on this forum.  They seem to be the same to everyone.  You might need to go through the Ombudsman.


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## dymo (5 Oct 2010)

Will have another look do i just need to put it in writing and send them a copy of my claim form and corresponce with them


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## Ravima (6 Oct 2010)

There must be an appeals procedure documented in your policy. try that route. In any event you must exhaust all other avenues open under teh company procedures before you can go to the ombudsman.

You do not give a great amount of info in your posting. You have the policy for 5 years and are self employed for the past few months. Did you tell them of the change of occupation? if not, you might be in trouble if your new self employed occupation is deemed a higher risk than the one you originally had.

Again, you are sick for a few months and after sending in the documentation to them, you waited months to hear from them. Could they think that you are better now? Did you ever follow up in the waiting period?


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## askU (11 Oct 2010)

dymo said:


> I have A sickness policy with combined for the last 5+ years and this is my first time in claiming form them.I am self employed but for the last number of months i have been out of work due to chronic sinicus i have been on tablets and am also waithing on a operation but as my chest has been too week they have this put off for another few week.
> 
> I put in my claim to combined and after a number of moths of nothing from them i am after resciving a letter from them stating that the belive my losess are excessive and they are olny willing to pay out for 24 days wich comes to €500.They have never asked that i be seen by an independent doctor or have never asked to see my xrays or anything i have also asked to speak to my customer respensive but all i hear is that they are in training.
> 
> ...


 
It depends on the type of plan. Is it a  Sickness Income Plan or Sickness Hospitalisation Income Plan that you have?


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