Mrs JG, a fibromyalgia sufferer, has managed to achieve a full payout under the Critical Illness section of her Life Insurance Policy.
38 year old Mrs JG from Chandlers Ford, Hampshire had been a Solicitor since November 2002. Following the birth of a child in 2004, Mrs JG began to feel terrible pain in her joints and all over her body. The pain affected her fingers, hands, elbows, neck, ribs, legs and feet. She also suffered with serious fatigue which swept over her body. Mrs JG returned to work in September 2004 for three days a week. She went on maternity leave in April 2006. Her maternity leave ended in April 2007 and she was unable to return to work.
Mrs JG had Critical Illness cover under her Life Insurance Policy. It entitled her to a lump sum payment if she became permanently unable to follow her normal occupation, taking into account current medical knowledge and technology. Given her continuing ill health, she made a claim under the policy in March 2007. Her Insurers would not admit the claim and Mrs JG continued to pursue the claim, but to no avail.
In February 2008, Mrs JG 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 Fibromyalgia. We looked at the documentation and asked the Insurance Company to disclose all documentation relating to the claim.
Despite the fact that Mrs JG’s treating doctors considered that she was unable to work, the Insurance Company insisted on obtaining a report from an independent Consultant Rheumatologist. This expert felt unable to state that Mrs JG had a “permanent untreatable disorder” and he recommended that Mrs JG undergo additional treatment including a residential Pain Management Programme. However, the insurers refused to fund the further treatment and Mrs JG did not wish to undergo the further treatments. She considered that she had already exhausted all forms of treatment and she felt that the Insurance Company were just making her jump through further hoops, in an attempt to continue denying the claim.
After a considerable fight we managed to convince the Insurance Company to back down and admit Mrs JG’s claim in full. The Insurance Company even paid Mrs JG some interest. Mrs JG is understandably delighted with the result.
We feel that this case 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 provision for permanent incapacity. Critical Illness, Permanent Health Insurance cover, Accident Protection and Mortgage Protection policies can all benefit Fibromyalgia and other chronic pain sufferers.
If you would like us to look at any policies you have, without obligation, please contact us.