One of the most common enquiries we receive is from people looking for help claiming on their Total Permanent Disability cover, as part of their Critical Illness policy. We have seen a significant number of customers come through to our service frustrated by their insurance providers never-ending need for medical evidence and information.
Before we go any further, I will explain, in basic terms, what is Total Permanent Disability cover (TPD). Most often TPD cover is taken as an additional benefit through a life or Critical Illness policy, much like the waiver of premium option. It is designed to cover people that perhaps have not been diagnosed with a critical illness (as defined within their policy terms and conditions) such as cancer or a heart attack but are unable to work ‘permanently’ due to an illness. The cases we see are typically chronic pain and fatigue conditions like Fibromyalgia and ME/CFS (Chronic Fatigue Syndrome) and ‘lesser’ forms of cancer where a Rejected Critical Illness Insurance claim pay-out has not been triggered but due to treatment or combined health conditions returning to work is unlikely. TPD cover will pay-out a lump sum often to the value of your Life and Critical Illness policy.
As I said above the main reason customers come to us for TPD claims seem to around the amount of medical information required, time taken to assess the claim and the burden of proof of what ‘permanent’ is. When you submit a claim under your TDP policy an insurance company will normally write to your GP and/or consultant to confirm that a diagnosis has taken place. They will most likely also ask questions about what treatment you have received, what treatment has been planned/being considered and what the likelihood of your return to work. In an ideal world this would take place within a few weeks and the insurance company would make a quick and speedy decision on your claim.
The overwhelming majority of people we speak to do not experience this. The average length of time we report for ongoing claims before people come to us is around 6 months, with the insurance company seemingly asking for a never-ending list of information from GP, occupational therapists, and consultants.
A case we had several months ago had an insurance company reject a customer claim under the Total Permanent Disability due to them believing their condition was not ‘permanent’ enough. This client had multiple health concerns including mental health and Chronic pain/fatigue conditions. Their consultants confirmed they had attempted all treatments and despite their best efforts their symptoms failed to improve. The advised that they could not say for 100% they would not return to work, but it was more likely they would not. We were able to prove that on the balance of probabilities and given all treatment options had been exhausted without any improvement, that the likelihood of the client returning to work was minimal, therefore permanent.
It was not easy though as there is extraordinarily little on what permanent means? Can an insurance company wait 5/10/15years to finally consider your conditions permanent? It would seem that this is what some insurance companies are doing. An increasing number of insurance companies are not really interested in what the most likely option is they are looking for almost a cast iron guarantee that someone is unable to work again. This is often hard for consultants and doctors to give as a) You can never be 100% certain and b) when you are caring for someone with chronic mental health and pain/fatigue conditions you never want to give up hope of the possibility things might improve. Insurance companies seem to be using this to their advantage in rejecting claims or declining claims without giving any weight to the balance of probabilities. We have been successful in overturning a large amount of wrongly declined Total Permanent Disability claims by using ABI guidelines, legal framework, and previous FOS decisions as benchmarks.
Of course, every case is different and at Resolute Claims we aim to provide a fair and honest assessment of your situation. We offer a free check and assessment to every person who feels they have been wrongly had their Rejected insurance claim declined or has taken an incredible amount of time to assess. Even if you do not decide to use our services your can call us for support and where to go next.