A family in Belfast has been struggling to care for their 16-year-old son who has a degenerative disease called spinal muscular atrophy with respiratory distress (SMA-RD). The disease has left him paralyzed in all four limbs and in need of round-the-clock care. The family has been paying £60 a month for a critical illness policy with Aviva since 2007, but the insurance company has refused to pay out, citing that the condition was present at birth and therefore not covered.
The family’s son was diagnosed with SMA-RD at the age of eight, but his health took a significant turn for the worse last year. His father has had to give up work to care for him, and the family contacted Aviva in January to discuss their eligibility for a claim. However, they were met with a lengthy and frustrating process, being transferred between three departments and waiting over three and a half hours to speak to an adviser.
Despite submitting medical reports and raising a formal complaint, Aviva denied their claim in June, stating that the condition was present at birth and therefore not covered. The family was devastated by the decision, which they felt was made without compassion or understanding of their situation.
The case was taken up by a consumer champion, who argued that the family could not have known about their son’s condition when they took out the policy, and that Aviva’s decision was unreasonable. The champion suggested that the company was rejecting the claim on a technicality, and that it was morally wrong to do so given the family’s circumstances.
Aviva responded quickly to the champion’s intervention, agreeing to make a goodwill payment of £10,000, which is the full amount allowed by the policy. The company acknowledged that its service and communication had fallen short of expectations and that the family’s situation had not been handled with the urgency and compassion it deserved.
The case highlights the importance of insurance companies showing compassion and understanding when dealing with customers who are going through difficult times. While companies must adhere to their terms and conditions, they should also be willing to consider the unique circumstances of each case and make exceptions when necessary. In this instance, Aviva’s decision to make a goodwill payment was a welcome acknowledgement of the family’s situation and a recognition that sometimes, compassion and empathy are just as important as following the rules.