Jane Elliott BBC News Online Health Staff

Andrew Hunneybel has received nothing

A year before he had taken out a health insurance policy and was confident that if he could no longer continue in his job as an electrical engineer that his family would be provided for.

But a row over the small print of the policy has left him bankrupt and relying on state handouts.

The 31-year-old, from South Woodham Ferrers, Essex, claims the policy holders Legal and General did not act fairly. They say he failed to read their documents properly.

Problems

Mr Hunneybel said he'd had to give work up this October after a muscle wasting problem caused his heart to slow.

Letters from his doctor confirmed that he was unfit to work and could not walk far without having to stop and rest.

If I had known about these tests I would not have taken that policy Andrew Hunneybel

He submitted his claim, but his insurance company told him it had been rejected because he could still carry out more than three of their functional assessment tests.

These included being able to answer the telephone, the ability to walk up a standard flight of 12 stairs, the ability to read a newspaper, to be able to get in and out of a standard car and the ability to write.

Mr Hunneybel said he had been unaware of these tests and that if he had been he would have never taken out the policy.

"I had taken out a health insurance policy to protect my income.

"If I had known about these tests I would not have taken that policy because to have been able to claim you would have had to be so disabled that you would not be able to pick up a telephone or read a newspaper.

"And at the end of the day I was signed off genuinely.

"The whole idea of a protection policy was because I had a young family that I wanted to protect."

Pay

Now Mr Hunneybel, his wife Louise and children Lily Rose, aged five, and Alfie, aged four, are surviving on Louise's part-time wages and his disability allowance of just �60 a month.

"I was awarded that because of my illness, but Legal and General will not pay me anything because they say I can still answer the telephone."

Mr Hunneybel, who received statutory sick pay of �63 a week for 28 weeks, said he had taken out the policy after suffering a burst appendix the previous year.

He agreed to pay �100 a month to be covered for income protection, critical illness and life cover.

But has received nothing.

And has now been declared bankrupt among a tide of rising debts.

"I just can't believe a company as big as Legal and General could be like this.

"My wife is now on anti-depressants."

Ill

His GP Dr John Cormack, who is backing his case, said Mr Hunneybel was not fit to work.

I think this is one of those unfortunate situations where the line the insurance company is taking seems to the policy holder to be harsh General Insurance Standards Council spokeswoman

He said that he knew of at least two other patients in his 6,000 list practice who were having similar problems, one with Legal and General and one with another company, which he said indicated a major problem nationwide.

"It just set the alarm bells ringing.

"He has chest pains. He can just walk a few yards on the flat and he is like an old man, but before he was fit and well.

"It is quite bizarre. What they appear to be saying is that OK he is unwell but that if he could lie in bed and read the British Medical Journal and then rehash that for Bella magazine then he could be employed.

"What he is saying is that is not his job and that he does not have the skills involved to do this job. His job requires him to life heavy equipment and drive a van and he can't do this.

"It is all rather bizarre."

Studied

But Peter Timberlake, of Legal and General said that although Mr Hunneybel claimed he had been unaware of the tests, they had been set out in his documentation and that his case had been the subject of extensive review.

"The original illustration stated that the benefit would be paid 'if as a result of illness or accident you are unable to carry out a number of specific tests.'

"The Key Features document provided with the illustration states that Mr Hunneybel would qualify for a benefit 'if you are totally unable to carry out three of six Functional Assessment Tests' (FATs) and refers him to his policy document for the definitions of incapacity relevant to his plan.

"The policy document provided full details of the incapacity definition and FATs.

"We have therefore rejected Mr Hunneybel's complaint that he was unaware of the FATs requirement.

"We have offered Mr Hunneybel the opportunity to be assessed against the FATs criteria by an independent medical examiner (at our expense) if he wishes to proceed with his claim under the policy.

"Our examination of his complaint though has revealed that his financial adviser did not adequately explain the conditions of the product.

"We therefore consider that the product may not have met Mr Hunneybel's requirements and we have therefore offered him a refund of premiums paid plus interest amounting to �633.62.

"This offer will remain open to Mr Hunneybel if he proceeds with the independent medical assessment but fails to meet the claim criteria.

"Mr Hunneybel has been given normal rights to refer his case to the Financial Ombudsman."

A spokeswoman for the General Insurance Standards Council said health claims were often subjective and as a result were the subject of a number of complaints from policy holders.

"I think this is one of those unfortunate situations where the line the insurance company is taking seems to the policy holder to be harsh.

"They are difficult claims to settle sometimes and, because of the subjectivity, it is an area where some policy holders in the past have abused it."

Isabel Berwick, of the Financial Times, said financial advisers were pushing income protection policies, because they relied on them for commission.

"Nobody is buying investments at the moment, so the kind of commission they get from selling these policies is going a very long way to keeping these guys afloat in very bad times."