Mrs GL of Norwich was injured in lifting incidents at work in June and September 2004. She suffered a back injury which became chronic and she developed fibromyalgia. Mrs GL claimed under her Accident Protection policy. She was unable to work after the second accident and claimed under the Permanent Total Disablement Section of the policy. She had to establish that she had sustained accidental bodily injury which within twelve months resulted solely and independently of any cause in death, permanent disability or hospitalisation.
After obtaining an opinion from an orthopaedic surgeon, the insurance company’s chief medical officer expressed the view (in a letter dated May 2006) that Mrs GL had been left with a 15% to 20% global disability due to the accident alone. Insurers therefore put forward a full and final settlement of 17.5%, namely £17,500.
Mrs GL promptly instructed us to look into the offer. We agreed to act under a Conditional Fee (“no win no fee”) Agreement in which “success” was defined as beating £17,500. We noted that the orthopaedic surgeon had indicated that the fibromyalgia was “very severe and aggressive” and had resulted in these severe physical incapacities. He also commented that he was no expert on fibromyalgia and that a report should be obtained from a rheumatologist or pain management consultant. We suggested to insurers that they should instruct such an expert, but they refused, saying that since it was now twelve months from the date of the accident any further report or examination would not be a true reflection of the level of disability that was present at twelve months post-accident. [This shows that insurers can come up with anything if they want to!]
Because we had had the audacity to question the £17,500 offer, insurers promptly withdrew it. They went back to the orthopaedic surgeon who agreed with the chief medical officer that one would not normally expect fibromyalgia to be the consequence of an accident such as this alone. He agreed the assessment that the accident had produced a 15% to 20% permanent disability. Therefore the offer of £17,500 was repeated in August 2006.
By January 2007 Mrs GL had instructed us to obtain reports from two rheumatologists. These were supportive. Insurers were requested to pay £100,000 under the terms of the policy. They again refused, seeking to pick holes in the two rheumatological reports and again formally withdrawing the settlement offer of £17,500 in February 2007.
The insurers finally decided that they should obtain an independent rheumatologist’s report and they promptly instructed the treating rheumatologist, presumably because he had said that the fibromyalgia had not been caused by the accidents (although he did not give any reasoning for that). So much for an “independent” examination!
Fortunately the treating rheumatologist disqualified himself and a new rheumatologist saw Mrs GL in December 2007. Insurers then appeared to resort to delaying tactics and therefore Court proceedings were commenced against them in February. Shortly after that Solicitors acting on behalf of the insurers conceded that Mrs GL was entitled to £100,000 and interest.
Brian Barr comments “£17,500 was a lot of money to Mrs GL and it took great courage on her part to have us challenge the insurers. They twice withdrew that offer and argued tenaciously against paying any more. We argued just as tenaciously that they were wrong and eventually they went to a doctor in the right discipline who was supportive of the claim. Mrs GL now has the insurance payment that she should always have received plus interest and we have shown again that insurers can be beaten if you know how to tackle them. Mrs. GL also had some kind words to say about us and I am happy to quote them:
What Mrs GL says about Brian Barr Solicitors…
“Without you I would have given up and backed down ages ago, as when you feel like I do, added stress and worry is a nightmare with this illness, but your being there kept me going.
“You are very professional and have worked very hard in achieving two good results for me over the last three years. Unlike many professionals, you have always been there and treated me like a person (human being) and not just a number.
“There is a great stigma surrounding chronic pain/Fibromyalgia from a lot of health professionals and other bodies, but as my cases have also proved, there are some out there who really do understand and indeed care about what people like me are going through, so there is hope yet.
“And with you, a great Solicitor, who has also produced a great team of staff and the health professionals who have understood and shown professionalism and care, I am truly grateful. No words will ever be enough to express my sincere thanks to you.”
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