Fibromyalgia - too ill to work? by Anna Illingworth
Individuals with fibromyalgia and similar conditions such as myalgic encephalopathy, or chronic fatigue syndrome and chronic pain syndrome can become too ill to work. Some of those people have the benefit of Permanent Health Insurance (PHI) which pays out a percentage of their lost income typically between 50% and 75%.
However insurance companies are not always willing to accept such claims and that is where I can help.
It is a complex area of law. The illnesses themselves are less well known, and less easy to understand. Often the entitlement to employment related PHI depends upon the person remaining an employee and yet employers can legitimately dismiss for capacity related reasons if they do so for fair reasons having followed a fair procedure. I can help employees understand and respond to these inconsistencies. Issues can arise which relate to contractual obligations and breach of those obligations, diagnosis and symptoms, disability and discrimination. It can be very difficult for people to address those issues and fully argue their case without legal support.
The best way I can show the type of problems that individuals can face and the results I can achieve is by way of example:-
Case Studies Permanent Health insurance
- W an Accountant became unwell. His health deteriorated quite quickly to the point that he could not work as an accountant. He claimed his lost income on his PHI policy and his claim was rejected. The insurer argued that although he could not work as an accountant he was able to do other types of work.
I challenged the insurer successfully by establishing that he was entitled to claim the income lost from his actual occupation
- X was an employee. She had worked for a company for four years and then became unwell. Once she had exhausted her employer’s contractual sick pay she claimed on her employee PHI policy with the support of her consultant rheumatologist. Her claim was rejected by the insurer relying on the report of an occupational health consultant.
I successfully challenged the insurer and established that her illness genuinely meant that she was unable to work. The Insurer started making payments to her and backdated them to the date of her original claim.
Several years later the insurer stopped making payments. It had employed a private investigator to follow my client and video and photograph her activities. On the strength of the investigators report and without any medical evidence at all it decided she was well enough to work. The insurer stopped making payments.
I successfully challenged the insurer again, with further support from her consultant rheumatologist. The payments were reinstated and backdated.
- Y was an employee who had become unwell and unable to work. She had successfully claimed on a PHI policy and received payments for just over three years. The insurer and her employer approached her to try to agree a way to bring her employment to an end without prejudicing her entitlement to PH payments in the future.
I successfully negotiated a settlement agreement that brought her employment to and end with a payment of compensation and transferred the PHI contact to her personally so that the PHI payments continued.
- Z was an employee in a similar situation to employee Y. However in her case, I negotiated a substantial lump sum payment from the employer and the PHI provider in return for which my client resigned from her employment and gave up her claims to future PHI payments.
Proud to support the Reading Fibromyalgia Support Group and the Newbury Fibromyalgia Support Group