Aviva, a leading insurance provider, found itself under scrutiny after a family’s claim for a critical illness policy was denied despite long-standing coverage payments. The incident comes on the heels of the company’s announcement of a £1 billion operating profit in the first half of the year, raising questions about the company’s customer service practices and its treatment of vulnerable clients.
NL filed a petition on behalf of their son. He now lives with a diagnosis of spinal muscular atrophy with respiratory distress (SMA-RD). Aviva’s reasoning for denying the claim was based on the belief that SMA-RD is a genetic disorder that exists at birth. Aviva’s policy was known as a birthday exclusion policy whereby they would only cover children after their first birthday, complicating matters further.
Following five months of negotiation, NL bounced between three different Departments and had to wait on hold for more than three and a half hours on calls. That was finally enough to motivate Aviva to authorize the payment. They paid NL the maximum £10,000 permitted under the policy, only doing so after initially wrongfully denying the claim.
Even with the rapid resolution that came after their decision, there have been substantial criticisms of Aviva’s handling of the case. The family said they were appalled at how heartless the insurance company acted during such a difficult time.
They were unable to pay the claim due to policy terms and conditions. They decided to give full weight to the unusual circumstances of the case.
“We fully acknowledge that our service and communication did not meet the standards our customers rightly expect from us. The family’s situation should have prompted a more urgent and compassionate response.” – Aviva
The case has sparked wider fears over the practices of insurance companies when it comes to paying out on critical illness claims, especially those made by children. It sheds light on the contradictions between corporate greed and prioritizing customer service. Aviva in March boasted a 66% jump in profits. Observers are asking whether this cash cow is coming at the expense of customer welfare.
“While we are unable to approve NL’s son’s claim because of the terms of the policy, we recognise the unique circumstances of this case and the shortfalls in our service, and believe that it is appropriate to make a goodwill payment that is equivalent to the benefit the family would have received had the claim been eligible.” – Aviva
Since 2007, NL has been underwriting £60 per month in critical illness cover. Their communities—of which the federal workforce is not—depend upon them in times of need. Many have turned to the once-reliable insurance policy only to find themselves facing long wait times and denied claims. This anxiety compounds, particularly when families face unexpected health emergencies.
Aside from this scary claims procedure, NL’s case highlights larger problems with Aviva’s customer service procedures that continue to plague the company. The ineffective and slow communication of decisions, made in opaque ways, piled frustration upon NL and their family. Without clear directions, they were left feeling powerless at the height of an already high-anxiety moment.
In addition to this troubling claim process, NL’s experience underscores issues with Aviva’s customer service protocols. The excessive time taken to communicate decisions and the lack of clear explanations contributed to feelings of frustration and helplessness for NL and their family during an already stressful period.