PMS sufferer refused medical cover for breast cancer treatment
16 Apr 2007
When Sue McCready, a senior charity manager in South London, was diagnosed with breast cancer 18 months ago at the age of 48, she had no reason to believe that her medical insurance would not come to her aid. However, she was to be shocked and stunned when she was refused critical illness insurance to which she had been subscribing since 2002.
The reason insurers Norwich Union stated were that at the time of her application, Sue had failed to disclose that she had been prescribed anti-depressants for her PMS symptoms. According to Norwich Union, Sue had not disclosed “recurrent episodes of depression mentioned in your GP notes starting from 1979. At times you have taken anti-depressants and been referred for counselling. Some of the periods have lasted for more than 3 months...”The insurers also referred to occasional use of alcohol for self medication in the past in 1984 and 1994, although Sue had been tee-total for 8 years prior to making the claim.
The relevant health question was worded: “Have you ever had any medical or surgical treatment, including investigations, tests, scans, X rays for any of the following illnesses or medical conditions: Mental or nervous illness (including depression) lasting more than 3 months and/or requiring more than 10 consecutive days off work.”
Norwich Union refused cover on the basis that: “our underwriters have confirmed that had they been made aware of your medical history they would not have been able to offer the same terms and conditions for this contract. They would have offered a contract for life cover at an increased premium and declined to cover you for critical illness benefit.”
Going to appeal
As Sue, who has three teenage children, comments: “ I am appealing against this decision as I have a history of PMS, which is amply documented in my medical notes since 1979 and I have been referred by my GP on at least two occasions to specialist PMS clinics. The consultant who treated me at one of these clinics wrote in my medical notes that I had classic symptoms of PMS. The insurers have chosen to completely ignore this information in my medical notes.”
Sue had persistently made it clear that her symptoms were severe prior to menstruation and improved for about 7-10 days from the onset of menstruation. She had never had time off work or been medically treated for depression. The anti-depressants and occasional use of alcohol were taken when her PMS became more severe than usual.
PMS is not a mental or nervous condition – it is due to hormonal imbalances. Low seratonin levels are implicated in PMS, but symptoms are distinguished by occurring cyclically in tandem with the menstrual cycle. Anti-depressants are often prescribed by specialist consultants to help with the symptoms.
Since diagnosis, Sue has undergone two operations, a rigorous programme of chemotherapy and radiotherapy treatment and is now taking herceptin, which will continue for a further nine months. Another minor operation is coming up in three months’ time. As a result of Norwich Union’s decision, Sue has had no choice but to continue working full-time during this ordeal to support her family and meet ongoing mortgage repayments.
“To deny insurance or refuse claims on the basis of PMS is blatant discrimination against women. I feel very strongly both for myself and for other women afflicted by PMS that it is a travesty of justice to claim that we are mentally ill rather than suffering from a little understood physical syndrome,” Sue says.
NAPS is appalled by this decision and would like to ask readers to contact us if you have had or are having a similar experience in dealing with private medical companies relating to PMS.
