Critical Illness Lawyers - Specialists in proving Chronic Pain for Insurance Claims

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.”

We do not endorse any research, studies or sources mentioned within our blogs and comments. Furthermore, we do not endorse any medical advice provided, and would strongly recommend anyone seeking medical advice to contact their local healthcare provider.

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.”

We do not endorse any research, studies or sources mentioned within our blogs and comments. Furthermore, we do not endorse any medical advice provided, and would strongly recommend anyone seeking medical advice to contact their local healthcare provider.