# income protection claim



## sparrow72 (20 Sep 2019)

I have been receiving an income protection for the last 7 years, the company I used to work for is the policy holder. In the last few years the insurance company is trying to stop the payment and I have been asked to attend several medical assessments where I was considered fit to work in all of them. Eventually the company will stop making the payments in that case I will have to go back to work. The problem is that I don't have an invisible illness, when I get sick I start vomiting and I need to lie down and stay still for several hours,in the past my employer had to call a taxi and send me home many times since it is not possible to work or drive my car in that condition. My disorder affect my muscles.  Can my employer end my employment in this case because I am not able to do my job?


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## Sophrosyne (20 Sep 2019)

Has your illness been diagnosed by a medical practitioner?


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## sparrow72 (20 Sep 2019)

Sophrosyne said:


> Has your illness been diagnosed by a medical practitioner?


I have a neurologist in London that already filled their form telling them that it is a permanent condition.He is one of the best doctor in UK regarding muscle disorders so I guess his opinion has a value. But last time the insurance company sent me to do a medical assessment with a GP that is an expert in providing assistance to the courts in complex occupational health cases. They are call me for assessments every few months, is this normal?


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## Sophrosyne (20 Sep 2019)

If your neurologist has certified that your condition is permanent and that it prevents you from working, then I think his/her opinion trumps that of the GP.


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## sparrow72 (20 Sep 2019)

Sophrosyne said:


> If your neurologist has certified that your condition is permanent and that it prevents you from working, then I think his/her opinion trumps that of the GP.


I really hope so,but I don't understand why they keep calling me for assessments. I have read about others that had their payment stopped and they did have all the documents from specialists that said they were not fit to work. In the case my payment will stop can my employer fire me because I am too sick to work?


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## Sophrosyne (20 Sep 2019)

The constant calls for referrals are probably to wear you down.

If I were you I would firstly keep good records of all contacts with the insurance company, letters, phone calls, dates, times, who you were referred to, etc., and secondly diary all of the symptoms of your illness so that your account will always be consistent.

I don't think your employer will fire you but you could be made redundant on ill health grounds.


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## sparrow72 (20 Sep 2019)

Sophrosyne said:


> The constant calls for referrals are probably to wear you down.
> 
> If I were you I would firstly keep good records of all contacts with the insurance company, letters, phone calls, dates, times, who you were referred to, etc., and secondly diary all of the symptoms of your illness so that your account will always be consistent.
> 
> I don't think your employer can fire you but you could be made redundant on ill health grounds.


 They certainly adding a lot of stress to my already stressful situation. I am keeping record of everything. I don't have a lot of symptoms, my muscles are just not working well and if I am not very careful I will vomit and not able to do anything else, that's it. Not sure what is a redundancy on ill health grounds but I will have a look, thanks


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## odyssey06 (20 Sep 2019)

Is there a catch 22 there... how could someone be made redundant on ill health and yet not pay out income protection as being unable to work?


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## Sophrosyne (20 Sep 2019)

Two things. There would have to be grounds for stopping income continuance payments.

Many employers prefer to make an employee redundant on ill-health grounds rather than arguing the toss. There is no set limit as to the length of time a person can be on sick leave in order to justify dismissal.


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## sparrow72 (20 Sep 2019)

why would the company pay for redundancy they already paid for an income protection plan for their employees?what's the point pay a premium if the insurance company would not pay when needed


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## Sophrosyne (20 Sep 2019)

Sometimes employers offer redundancy on ill-health grounds. Obviously, were you to accept redundancy your income continuance payments would cease.

However, your employer could still dismiss you on the basis that your absence is causing business difficulties, but this can be a thorny issue for employers.

You might be better to seek legal advice on your income continuance as it very much depends on the facts of each case.


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## gimp (21 Sep 2019)

You are claiming on a Company Policy. They own it. You cannot be made redundant if you are sick claiming on an Income Protection Policy. If you are permanently unfit for work you need the Income Protection Policy for life. You will remain an employee of this company as the Income Protection payment is made to them and then they pay you. You do not own the Policy. You must keep your employer in the loop.
You also cannot work if your Doctor, Consultant does not certify you fit to return to work. End of story . No quack GP provided by the Insurance company can certify you over your Specialists. Ask them to provide evidence of their GP's qualification to make a decision on an illness you have to consult a Specialist over. No GP holds sway over a Consultant Neurologist
Is the Insurance Company a Certain "Irish" company ? They will always try to disprove your claim. Ask them a simple question.......... are they calling your Consultant a Liar. Better still get you Consultant to draft a letter asking that question as that is what they are doing. You need to fight them on this. You have the reports and Consultant on your side.


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## Sophrosyne (21 Sep 2019)

gimp said:


> You will remain an employee of this company as the Income Protection payment is made to them and then they pay you.



Unfair Dismissals Act, 1977, section 6(4)

*Not unfair dismissals*

(4) Without prejudice to the generality of subsection (1) of this section, the dismissal of an employee shall be deemed, for the purposes of this Act, *not to be an unfair dismissal*, if it results wholly or mainly from one or more of the following:

*(a) the capability, competence or qualifications of the employee for performing work of the kind which he was employed by the employer to do,*

(_b_) the conduct of the employee,

(_c_) the redundancy of the employee, and

(_d_) the employee being unable to work or continue to work in the position which he held without contravention (by him or by his employer) of a duty or restriction imposed by or under any statute or instrument made under statute.


Section 6(4)(a) covers, inter alia, absences due to sickness.

It is sometimes assumed that people on sick leave, notwithstanding an income continuance policy cannot be dismissed.

They can.


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## DirectDevil (23 Sep 2019)

I have come across this problem a few times.
Some of this is about IP insurers taking a self-interested bullying approach to claimants in the hope that they will go away.

MEDICAL EXAMS.

In relation to medical examinations there is probably a condition in the insurance contract obliging you to submit to medical examinations by their medical referee. Sadly, some of these referees would be better described as hit-men as some have objective bias in relation to certain types of conditions.

DOCUMENTS.

My first port of call would be to see the written terms of the sick pay / ill health / income protection as provided by your employers.
Next, I would want to see the terms of the insurance contract.
Technically, you are not the policyholder but you are probably an insured person subject to the terms and conditions of that contract.
Much flows from these two sources.

PROOF.

In claims of this type it is for the claimant to prove that an insured event has occurred.
The standard of proof is the civil standard of the balance of probabilities i.e. at least 50% more likely than not.
IMHO a clear and confirmed diagnosis of the condition from a consultant neurologist should outweigh that of a GP who, like some of them, has a post-graduate specialism in occupational medicine.
The trouble is that some insurers will see a report from "their" "independent" doctor as enough to justify termination of benefit where that opinion suits their convenience.

OMBUDSMAN.

You may have to consider a complaint to the Financial Services & Pensions Ombudsman.
This is not a soft option. Any finding they make is legally binding on the parties to the dispute.
Any of the parties can appeal a FSPO finding by way of a rather onerous High Court case.
I would threaten but reserve this option for now.
LINK https://www.fspo.ie/

SOLICITOR.

You may have to consider instructing a solicitor to pursue this for you.
A sufficiently strong originating letter that shows resolve not to be pushed around might resolve it.

WHAT WOULD I DO IN YOUR POSITION ?

Write to the insurers and demand a written justification for and explanation of their position.
Point out that you have submitted medical evidence of a sufficient degree of medical expertise, competence and standing to establish proof that an insured event has occurred and that your evidence is to the required standard of proof.
Threaten that in the absence of a satisfactory response you will reserve the right to instruct a solicitor to pursue this for you and or you may consider a formal complaint to the FSPO.

P.S. - ARBITRATION.

I forgot to say to check the policy wording for an arbitration condition. 
If there is one it probably compels that the matter be referred to arbitration and that it ousts alternative legal remedies.
If arbitration is to be considered it would be wisest to instruct a solicitor as the procedure has technical complexities.

And finally, don't let the underwriters ground you down... I had another word for underwriters but I don't want to be banned..


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## Steven Barrett (23 Sep 2019)

gimp said:


> You are claiming on a Company Policy. They own it. You cannot be made redundant if you are sick claiming on an Income Protection Policy. If you are permanently unfit for work you need the Income Protection Policy for life. You will remain an employee of this company as the Income Protection payment is made to them and then they pay you. You do not own the Policy. You must keep your employer in the loop.
> You also cannot work if your Doctor, Consultant does not certify you fit to return to work. End of story . No quack GP provided by the Insurance company can certify you over your Specialists. Ask them to provide evidence of their GP's qualification to make a decision on an illness you have to consult a Specialist over. No GP holds sway over a Consultant Neurologist
> *Is the Insurance Company a Certain "Irish" company ?* They will always try to disprove your claim. Ask them a simple question.......... are they calling your Consultant a Liar. Better still get you Consultant to draft a letter asking that question as that is what they are doing. You need to fight them on this. You have the reports and Consultant on your side.



Reading this thread, there was only one company that I was thinking of...


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## sparrow72 (28 Sep 2019)

DirectDevil said:


> I have come across this problem a few times.
> Some of this is about IP insurers taking a self-interested bullying approach to claimants in the hope that they will go away.
> 
> MEDICAL EXAMS.
> ...



Thank you for all your replies

Yes the company is the "Irish" one and I have read other posts about people that have my same problem.

I even got sick at the last medical assessment because the taxi I booked didn't come and I decide to drive, I thought I could drive over there because it was just 15 minutes drive, but I wasn't able to drive back home. I had to stay at the GP office nearly 3 hours lying in a bed unable to move and vomiting. The GP kept coming to check my heart and my blood pressure I could see she was panicking but I told her there is nothing she can do, I just have to wait. She had to stay there over time because nobody couldn't come to pick up me and I was unable to walk. She even asked me why did you come if you were so sick? lol. I was thinking that she could understand my level of disability, my car is even an automatic car I wouldn't be able to reach her office if it was manual. But I read her report and she said that she admits that there is something wrong with me but the fact that doctor said I am not fit to work made me more lazy and demotivated. I saw her a second assessment and I told her I read her report and I asked how she thought I can even reach my work place. After a couple of month the insurance wrote me that they decided that I was still entitled to a payment,but then after a couple of months they called me for another assessment? I don't understand

In the insurance contract I requested time ago to my employer, is written : the insured persons as often as required by the company shall submit to medical examination and test. Failing or refusing compliance with these requirement to the satisfaction of the company and within such time as the company shall deem reasonable no benefit shall be paid

From what I understand they can call me for as many medical assessments  they want

For the first years the insurance company didn't bother me but after I submitted a genetic test where they found a rare mutation in a muscle gene I think the company realised that I am not going to get better but I am not going to die any time soon for my condition and since then they are calling me for many assessments.

If they accepted my claim and for a few years they paid with no problem if they want to stop the payment I guess they are the ones that have to proof that my condition has improved in some way.
In the past I had a solicitor sending to the insurance company a letter but unfortunately they keep calling me for assessments, I might contact him again to ask what I should do know and maybe submit a complain to Ombudsman.

Regarding arbitration I found this in the contract
If any difference shall arise between the company and the employers as to any matter relating to this policy such difference shall be referred to arbitration pursuant to the provisions of the arbitration act 1954 and 1980
not sure what this means but I guess this involves only the employer?


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## cremeegg (28 Sep 2019)

_" if they want to stop the payment I guess they are the ones that have to proof that my condition has improved in some way."_

I don't think this is the way it works.

If this is in the insurance contract.
_
"the insured persons as often as required by the company shall submit to medical examination and test. Failing or refusing compliance with these requirement to the satisfaction of the company and within such time as the company shall deem reasonable no benefit shall be paid"_


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## sparrow72 (28 Sep 2019)

_"the insured persons as often as required by the company shall submit to medical examination and test. Failing or refusing compliance with these requirement to the satisfaction of the company and within such time as the company shall deem reasonable no benefit shall be paid"_

this means that if I refuse to go to the assessment they will stop pay the income. Am I wrong? English is not my first language.


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## Bronte (30 Sep 2019)

That GP is a disgrace.  Yes Sparrow it seems you must go as that is what that clause means.  But it is clear that you are so ill that going to an assessment is medically not advisable. I'm surprised the GP did not write that in her report.  I would write to the insurance company telling them that their own GP thought you were too medically unwell to attend.  This is disgraceful bullying by the insurance company.  Seems to me you need a solicitor. Also you should make a complaint to the medical council and the ombudsman.


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## cremeegg (30 Sep 2019)

Bronte said:


> That GP is a disgrace.



Which GP is a disgrace ? the one that _ "stay(ed) there over time because nobody couldn't come to pick up me"._

Or are you second guessing the medical assessment of the insurance company's doctor. Now Bronte you know I have great respect for your opinions on property rental and general common sense, but even I would be surprised if you could determine the OPs fitness to work based on this thread.

The OP seems to think that their medical condition is such that they can receive an income for life from the insurance company, and indeed that maybe the case.

It seems that the insurance company paid for some years and more recently wanted to investigate if the OP was recovered or recovering. Their medical assessment seems to think so.




sparrow72 said:


> I have been receiving an income protection for the last 7 years, the company I used to work for is the policy holder. In the last few years the insurance company is trying to stop the payment and I have been asked to attend several medical assessments where I was considered fit to work in all of them.





sparrow72 said:


> I have a neurologist in London that already filled their form telling them that it is a permanent condition.



One can be suffering from a condition on a permanent basis, that does not necessarily preclude a return to being fit enough to work. The insurance company is not being unreasonable in asking for further assessments.

The surprising thing about this is that after their medical assessment found the OP fit to work they did not cease payment.

In all this we are hearing only the OPs view. I have often thought that insurance companies try to avoid paying out, but to my mind this is not a clearcut case of that.


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## sparrow72 (30 Sep 2019)

cremeegg said:


> Which GP is a disgrace ? the one that _ "stay(ed) there over time because nobody couldn't come to pick up me"._
> 
> Or are you second guessing the medical assessment of the insurance company's doctor. Now Bronte you know I have great respect for your opinions on property rental and general common sense, but even I would be surprised if you could determine the OPs fitness to work based on this thread.
> 
> ...




Honestly I am looking forward for them stop the payment so all this drama finally will be over and I can proceed through legal channels and let a third party make a decision because the insurance seems incapable (or unwilling) to do so.


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## DirectDevil (5 Oct 2019)

QUOTE 
Regarding arbitration I found this in the contract
 If any difference shall arise between the company and the employers as to any matter relating to this policy such difference shall be referred to arbitration pursuant to the provisions of the arbitration act 1954 and 1980
 not sure what this means but I guess this involves only the employer?
QUOTE ENDS

That sounds like a standard arbitration condition.
It does seem from the wording that it applies as between employer and insurer only.
I might say differently if it said insurer and policyholder if the term policyholder was defined to include employees.

A common problem here is that some employers will simply sit back and say that if the insurers say X well then that is also what we say.
The employers have responsibilities and rights in this situation and must not be left to renege by apathy or indifference.
Some policies contain a condition that sets a time limit between repudiation of a claim and the commencement of arbitration.
If you do not commence arbitration within any such limit the claim might be deemed to be abandoned.  

I would urge you most strongly to now please consult a solicitor. 
There are quite a number of legal issues raised by your problem and they need professional legal attention.


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## Esmerelda (15 Jan 2020)

Hi in reading these posts with severe dread. I was paid IP from 'Irish' company through employers for 6 yrs and recently they have ceased payment saying I'm running a buisness. I've seen solicitor and am waiting for letters from my psychologists stating its occupational therapy  truthfully it is but am wondering what the success rate of an appeal is? Theres no likelihood of returning to work I've a degenerative disease . Any advice.


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## DeeKie (15 Jan 2020)

Are you running a business? What reason would they have for saying that?


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## Esmerelda (15 Jan 2020)

Hi thanks for reply. I took up soap making as a hobby as recommended by psychologist and then am attending a local farmers market once a month where I sit at a table and yes hopefully sell my soap.  The idea was to get out of house for my mental health and this seemed a great idea , so yes I have sold the soap. So I'm not sure if it's gonna stand up in an appeal.  Regardless if I didn't make money or covered the cost of making it.


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## stefbomb (19 Jan 2020)

Hi Esmeralda, I am sorry this is happening to you. From what I understand you can't do any paid job when you are receiving the income protection. I know soapmaking and going out once in a month it is not a proof that you can work 40 hours a week but they will do anything to stop to pay you so you need to be very careful. I can give you a contact of a solicitor that is an expert in the field if you like.


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## Esmerelda (20 Jan 2020)

stefbomb said:


> Hi Esmeralda, I am sorry this is happening to you. From what I understand you can't do any paid job when you are receiving the income protection. I know soapmaking and going out once in a month it is not a proof that you can work 40 hours a week but they will do anything to stop to pay you so you need to be very careful. I can give you a contact of a solicitor that is an expert in the field if you like.


Thanks for reply.  Yes I need to find a solicitor who knows this law. I depend on this.


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## Esmerelda (19 Dec 2020)

sparrow72 said:


> Honestly I am looking forward for them stop the payment so all this drama finally will be over and I can proceed through legal channels and let a third party make a decision because the insurance seems incapable (or unwilling) to do so.


Wondering how you have failed with this . A year later now.


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