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£150,000 Compensation Payout For Fibromyalgia Sufferer Under Critical Illness Policy

44 year old LB from Basingstoke, Hampshire had been a nursery nurse for 22 years until she developed Fibromyalgia. This stopped her working in January 2005. She suffered a constellation of nasty symptoms which made it impossible for her to pursue her demanding employment.

It was initially hoped that LB would be able to return to work but this was not the case. She was subsequently dismissed on the grounds of ill health in April 2007.

LB had a Critical Illness insurance policy. It entitled her to a lump sum payment if she became permanently unable to work in her own occupation as a nursery nurse. It was a policy she had taken out to provide her with some protection should she be unable to work. Given her continuing ill health she made a claim under the policy in January 2006. Insurers duly rejected the claim in August 2006. LB continued to pursue it, but to no avail.

She made no progress with insurers for some 18 months. Finally, in February 2008, LB contacted Brian Barr Solicitors to see if we could assist. She felt she had gone as far as she could on her own and she needed some expert input from solicitors who understood FM. We looked at the documentation and advised the insurance company that they should be paying out under the policy. They started to become more proactive and proposed that functional capacity evaluation be arranged to assist them to review the case. We objected to this. These evaluations are not appropriate for Fibromyalgia sufferers. The appropriate expert to report on LB was a Rheumatologist or Pain Consultant.

The insurance company finally agreed with this and an appointment was made with a suitable expert. In the meantime we requested and received a copy of a report prepared by a nurse instructed by the insurance company. The document was supportive and we insisted that it was sent to the expert.

Following sight of the expert’s report, the insurance company accepted the claim and LB received just over £150,000 in August 2008, just six months after we had first been instructed.

Lyndsey Ryan, Associate at Brian Barr, comments “This case again shows that we can make a real difference on these insurance claims. People often feel that Critical Illness cover just means specific conditions like cancer, strokes and heart attacks but invariably there will be provision for payment in the event of total permanent incapacity, usually defined as being unable to work until normal retirement. Likewise, Accident Protection policies will frequently refer to loss of specific limbs, but will also have a provision for permanent incapacity. Critical Illness, Permanent Health Insurance cover, Accident Protection and Mortgage Protection policies can all benefit FM and other chronic pain sufferers.”

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