Aviva won’t pay £50,000 claim because I had cardiac arrest… not heart attack: SALLY SORTS IT

I suffered a cardiac arrest last November, but insurer Aviva says I am not eligible for benefits under my £50,000 critical illness policy because it only covers heart attacks and not cardiac arrest.

I always thought they were one and the same. Since then I have been given a happy dance by the insurer. Can you please help?

RG, Surrey

Sally Hamilton replies: You described to me with remarkable calm the terrifying events of last November – although you said your wife had to explain them to you because you have no memory of what happened that day.

You woke up with flu-like symptoms and after first consulting your brother-in-law, a GP, you followed his advice to see your own GP.

He took your pulse, which was 300 beats per minute, while a normal heart rate is between 60 and 80.

You were sent to the emergency room, where you went into cardiac arrest shortly after arrival and were out for approximately twelve minutes before being resuscitated.

You were in a coma for ten days on multiple organ support, and you weren’t expected to survive.

Even when you unexpectedly regained consciousness, your wife and daughter were told that you may have suffered permanent brain damage and may require a wheelchair.

As the weeks passed, fortunately this frightening prognosis did not materialize and after a month in intensive care you were discharged on December 27 and returned home without the aid of a wheelchair.

Even though you may be in much better shape than predicted, your heart is still – and always will be – too weak to allow you to return full-time to your profession as a self-employed carpet and oven cleaner.

At 55, you were naturally concerned about the impact this would have on your family finances.

You believed the critical illness policy you set up with Norwich Union (now Aviva) in 2001 would be a financial lifeline.

But your cardiac arrest claim was rejected twice – first after your wife called Aviva while you were in a coma.

Unfortunately, older policies like yours normally cover a heart attack but exclude cardiac arrest. Few people, other than those in the medical field, understand the difference.

Cardiac arrest occurs when the heart stops pumping blood around the body, normally due to an irregular heart rhythm (as happened to you). During a heart attack, part of the heart muscle dies, perhaps due to a blockage, a clot or a narrowing of the arteries.

Cardiac arrest is now covered as standard in many more modern critical illness policies. Even Aviva has been using it for years.

It was excluded from older plans because, to put it plainly, people rarely survived cardiac arrest. Life insurance was therefore the relevant policy. Thanks to medical advances, victims are more likely to survive.

When you were knocked back for the second time due to cardiac arrest, Aviva suggested you might qualify for total permanent disability, but that couldn’t yet be determined because the insurer said your condition might change.

You were stunned, as your heart is now functioning at about 35 percent of its full capacity and you have been told that it will never return to normal.

You are also fitted with an implantable cardioverter-defibrillator, a type of pacemaker that helps control the rhythm of your heart.

That’s when you came to me for help. I have investigated two similar cases where cardiac arrest claims were denied and after asking the insurers to reopen the claims, they were able to find a way to pay.

In your case, I was immediately struck by the references to coma, a condition that I thought would lead to a payout.

Armed with this argument and other details you had given me about your incident, I asked Aviva to take another look.

It took only a few days for the insurer to confirm that it would pay out after all – under the coma definition.

Your £50,000 payout was quickly transferred to your bank account, with £750 added as an apology for the poor service you received.

You were elated and said that the money would allow you to pay back the friends you borrowed money from after the incident.

It will also give you the breathing space to focus on further recovery before (hopefully) returning to work.

Carpet cleaning will not be possible because of the heavy equipment involved, but you hope to be able to return to oven cleaning part-time.

An Aviva spokesperson said: ‘We are very sorry that our customer did not receive the claims experience he should have received.

‘In assessing the matter, and in light of the new information made available to us, we may pay a claim under the coma definition on the policy.

‘We always try to pay as many claims as possible, and although the policy did not cover cardiac arrest, we regret that we did not fully investigate whether he met the coma definition during our initial discussions with him.’

Aviva said it will take steps to improve the claims process as a result of your experience.

I sincerely hope that other insurers learn from your story and realize the importance of gathering all the facts at the beginning of a process so that customer claims are not dismissed without proper attention.

Missing Nintendo games

On October 9 last year, during my usual online grocery shopping at Asda, I ordered two Nintendo games at £40 each for my grandson’s Christmas present.

I immediately wrapped them up and set them aside. On Christmas Day, my grandson opened the packages and found only dummy boxes without games. This caused great unrest.

I contacted Asda several times but no refund was offered. I was told to return the cases to the store, which I did, but again I was not given a refund.

The online supermarket manager then promised a refund and a £20 goodwill voucher, but nothing materialised. Now I have no goods and no refund. Please help.

KE, Yeovil, Somerset

Sally Hamilton replies: I remember the consternation when I was young when I received a battery-powered toy for Christmas that came without batteries.

So I can imagine your grandson’s disappointment when opening the empty game boxes.

I asked Asda to put things right as you had waited far too many weeks for redress.

Asda has investigated this and, to my satisfaction, quickly apologized, refunded your £80 and sent you a £20 voucher for the inconvenience.