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Legal Advice: Income Protection Claim Appeal after Year-Long Illness

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  • 02-08-2023 8:26pm
    #1
    pocc45
    Registered Users Posts: 2 ✭


    Hi everyone,

    I wonder would anyone have advice for me in my current situation. It’s hard to summarise and I’ve missed some of the detail. 

    I stopped working for a year starting last July because I was very ill. For 6 months my employer paid me my full wage and then I had to make a PHI claim to their insurer.  

    The insurer took over 3 months to do their independent assessment by which time I’d already reached out to my employer to begin a phased return to work. They’re using the assessment as evidence that I had not been totally incapable of performing my occupation at the time of my claim. 

    They say their independent assessment was done as quickly as possible because they had been waiting on a report from my GP. That feels very arbitrary to me as they already had a report from my treating specialist stating I was unable to perform my occupation, and the GP’s opinion isn’t even considered in an appeal - it’s only the treating specialist’s opinion that counts there. 

    I am going to appeal the decision. However, it’ll cost me £375 to get a more detailed report from my treating specialist as to what factors exactly meant I couldn’t perform my occupation (this is what the insurer calls out as required in their appeals documentations). 

    It all feels like total nonsense to me. Why would they have to wait for the GP report to do their assessment? Why didn’t they ask for more detail in the first place? Why is it on the sick person to chase people in this system? 

    I’m wondering do I have any chance in an appeal? Is it worth getting the more detailed report? Should I just appeal with the existing report and then go to the ombudsman and save myself £375?

    It’s worth noting I haven’t been perfect during the process. I was a bit late submitting my phi application because my employer only told me about it on the due date. I didn’t chase my GP to get the report in asap. But I was in bits sick. 

    TL/DR: Insurer took 3 months to do an independent assessment and used it to deny my claim. What do?

    Post edited by Beasty on


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