A broker has hit out at Legal & General (L&G) for taking nine weeks to pay a family’s critical-illness (CI) claim despite it being a “clear-cut case”.

The client, James*, was diagnosed with a brain tumour in April after collapsing while at work as a joiner in Northern Ireland. Since then, the 39-year-old father-of-three has been unable to earn a living as he has been undergoing treatment.

His wife, Kate*, is a hairdresser and had been on the brink of returning to the salon after lockdown rules eased but was prevented from doing so when her husband became ill. She has been ferrying James to and from surgery and medical scans in addition to looking after their children.

While waiting for L&G to make a decision on their case, the couple have had to go onto Universal Credit and borrow from their family in order to pay their mortgage and other bills.

The payout, which has now been agreed, will cover their £65,000 outstanding mortgage and substantially reduce their monthly outgoings.

Kate says: “The delays have left us totally stressed out at what was already an immensely difficult time.

“We were just worried for the children and feared that we would not be able to keep a roof over our heads. We have been so lucky that we have had family to help us, but we are speaking out because there will be some people who are much worse off than us and who don’t have anyone to support them. We don’t want anyone else to have to go through this.”

CI claim delays can have a huge impact on the customer’s quality of life if they are fretting about paying their mortgage at the same time as going through treatment

James was diagnosed with a grade II astrocytoma, which is a form of cancerous brain tumour that is treatable but not curable. The tumour has been removed but the couple have been told that it is almost certain to return. James is mid-way through a course of radiotherapy that is five days a week for six weeks, after which he will need a lengthy course of chemotherapy and will continue to require his wife’s care.

The couple’s broker, The Mortgage & Insurance Shop senior adviser Michael Norwood, says: “The delays were unacceptable and avoidable. In the past I’ve had CI claims that have been paid out in under two weeks, so for this to take more than two months is appalling. It has put an unnecessary extra strain on the family.

“With CI claims, it is so important that they are dealt with quickly because delays can have a huge impact on the customer’s quality of life if they are having to fret about paying their mortgage at the same time as going through treatment.”

Norwood says the level of detail required by the insurer on the authority form to allow the broker to handle the claim on behalf of their client is overly bureaucratic.

In the case of his client, these forms were sent out with a page missing, which was part of the reason for the delay. The authority form also required the client to provide the broker’s address and date of birth, which Norwood feels is excessive. He has not had to jump through the same hoops when dealing with other insurers.

We recognise this is not the service level our customers expect. We are reviewing our processes

Obtaining a client’s medical notes can take time, but Norwood says that, when the claim form was submitted, L&G insisted the form be reviewed by its staff before it would put in a request for the patient records.

Given the inevitable delay in securing these, Norwood believes that L&G should have put in the request for the notes straight away, instead of waiting until it had the staff available to review the forms before initiating that process.

He says he sent the insurer the pathology report from James’s consultant at an early stage, which confirmed the diagnosis, and this should have helped speed up the process.

However, despite the delays, Norwood says his clients’ case shows why it is so important for families to take out CI cover with their mortgage.

An L&G Insurance spokesperson says: “The payment has now been made to [James].

“The delay was caused by a combination of factors including high Covid-related enquiries and delays in receiving medical evidence.

“We recognise this is not the service level our customers expect. We are reviewing our processes with regard to this claim and the broker information required for letter of authority. Our customers are our upmost priority and we wish to convey our best wishes to [James] and his family at this time.”

I think the industry has done well with efficient payouts during this period

Some brokers have reported delays in dealing with other insurers.

Ash-Ridge director Jane King has not had to process any claims on behalf of her clients recently but says that delays for some insurers to assess new applications have been “farcical”, although part of the problem has been GP surgeries taking a long time to send reports.

She says: “I have clients who had waited weeks to book a medical and even longer for a GP report to be produced. Once these are completed, underwriting is then taking forever to procure the evidence and make a decision. My concern is that, if these applicants died or were ill, they would have no cover through no fault of their own.”

But Cavendish Ware associate director Roy McLoughlin says he has not encountered delays in payouts in his own dealings with insurers. He says: “On the contrary, I think the industry has done well with efficient payouts during this period.”

*The clients’ names have been changed.