Irish Life declined my Income Protection claim - how to successfully appeal ?

warrior2012 · 30-10-2012 09:39PM #1

Hi
I suffer from depression and anxiety. I have been on a sick live for a few months. After 6 months I sent the income protection claim to Irish Life and my claim was declined (my employer is the policyholder) . The reason for declining the claim was that in "Independent" Medical Report, the psychiatrist, who was paid by Irish Life said that I am fit to work.
They told me that I can appeal their decision. In order to do this I need specialist opinion that I am not fit to work. I went to a psychiatrist and her opinion is that I am not fit to work. I will have the psychiatrist report shortly and I will appeal.

Do you have any experience with income protection and/or Irish Life which you can share with me? I will appreciate any advise, which can help me to appeal successfully.

I have heard that Irish Life declines claims very often. Thy hope that people will give up and will not appeal.

Many Thanks

Liam D Ferguson · 31-10-2012 03:32PM

If you have a written report from an independent psychiatrist saying (without qualification) that you are unable to work, then I would expect Irish Life to pay your claim.

As a broker, I have seen one situation where Irish Life's appointed medical examiner felt that a client was able to work. The client's doctor disagreed. Irish Life resumed paying the claim.

I have heard that Irish Life declines claims very often. Thy hope that people will give up and will not appeal.

Did the person who told you this have any actual facts to back this up, or was it just an opinion? I have no connection to Irish Life - as a broker they are just one company we deal with out of twenty-three who we act as agents for. In my firm, we have four clients on Income Protection claim at the moment. Two with Irish Life and two with Friends First. All four claims were accepted.

Between 2006 and 2010 Irish Life paid out €272 million in Income Protection claims alone, which was 15,500 claims.

If you are medically unfit to work, your claim will be paid.

rosehip · 31-10-2012 07:30PM

Your best bet is to go over to the illness and disability forums on this site and scroll through or search for "Irish Life" and "income protection policy".

I have just looked for a thread i saw where multiple people with M.E./CFS had been cut off their ip by Irish Life lately but i can't find it. There is also a cancer ip thread which has info in it for general purposes.

I know people having a terrible time with Irish Life. Just remember the doctors are never independent- they employ a panel of different ones. Look them all up on the internet and see their websites. Research everything and if you are not up to the fight try to find someone in your family/circle who can help you.

Also everyone, remember Irish Life OWN Cornmarket so they are NOT independent brokers (even though they say they are).

I can't help anymore than that but best of luck with it.

Henry Ford III · 01-11-2012 08:41AM

rosehip wrote: »

Your best bet is to go over to the illness and disability forums on this site and scroll through or search for "Irish Life" and "income protection policy".

I have just looked for a thread i saw where multiple people with M.E./CFS had been cut off their ip by Irish Life lately but i can't find it. There is also a cancer ip thread which has info in it for general purposes.

I know people having a terrible time with Irish Life. Just remember the doctors are never independent- they employ a panel of different ones. Look them all up on the internet and see their websites. Research everything and if you are not up to the fight try to find someone in your family/circle who can help you.

Also everyone, remember Irish Life OWN Cornmarket so they are NOT independent brokers (even though they say they are).

I can't help anymore than that but best of luck with it.

Who mentioned Cornmarket?

ravima · 01-11-2012 08:37PM

The policy is in the name of your employer. What are the terms and conditions. Some policies cover you if unable to do ANY occupation, whilst others cover you from your USUAL occupation.

if the former, then you are probably able to do some job.

Why not talk to HR?

warrior2012 · 02-11-2012 09:00PM

Hi All
Thank you very much for all your posts.

Ravima
In a letter from Irish Life I have found the below definition:
“As you are aware, disablement is deemed to exist where the insured person is unable by reason of illness or injury to carry out the duties of their normal occupation and is not following any other occupation.”

HR Dept doesn’t wont to send me a copy of terms and conditions. When I asked them about this before sending my claim they sent me Employee handbook, which doesn’t include terms and conditions. After I received the information that my claim was declined I asked HR Dept again but unsuccessfully. I think that I have to escalate. I am really curious what is there, that they don’t want to send me this document.

On Irish Life website I have found (both attached):
Draft_IP_Policy_Document & IP_Claims_Guide_for_Employers
I am not sure if this is the some policy (terms and conditions), which my employer has bought.

Liam
To appeal I need to send the specialist report saying that I am not fit to work. Does it make any sense to attach any additional documents? or maybe it is better to wait with this for Irish Life respond to my appeal?

Thanks a mill

Henry Ford III · 02-11-2012 10:10PM

Write to ILACsaying that you wish to appeal.

Ask them what's needed, and what is the procedure.

ravima · 03-11-2012 12:56PM

looking at it a different way, perhaps it's a good thing that the Irish Life medic thinks that you are fit to go back to work, because then your employer will take you back.

getting back to work can be and I stress CAN BE, a great help in overcoming/beating depression.

Azures · 12-11-2012 01:39AM

I was sent to see a dodgy doctor by an illness protection company - his report never mentioned my job - but the claims still cancelled my claim, I've sent 5-6 reports all opposing their doctors view, not only did they hold an appeal meeting which I was not allowed to be represented at , but they refused to show me the written decision for the original decision or the appeal, I'm still on leave, 6 months after their doc said I was fit to work , I have no money and the company have restarted the policy charges, I have no money to pay it, and no way of ever making a claim on the policy now as I am not working, but if I cancel it I can't appeal to the ombudsman either. I am getting into serious debt because of them. They only care about getting out of the policy contract. They are immoral. They also will not reply to my letters. Be warned- they are unaccountable, all powerful, and if they can get a doctor to write a report to stop your claim, they will and there is no appeal system in reality- just secrecy and disrespect for the customers who pay their salaries.

Azures · 12-11-2012 01:41AM

ravima wrote: »

looking at it a different way, perhaps it's a good thing that the Irish Life medic thinks that you are fit to go back to work, because then your employer will take you back.

getting back to work can be and I stress CAN BE, a great help in overcoming/beating depression.

Just wondering- do you work for Ir Li Ravina?

HowFinancial · 12-11-2012 04:56PM

Hi Warrior,

You mentioned that your employer is the policyholder. You should ask HR who to contact about your employee benefits (which may include pension plans as well as income protection plans).

There is normally a broker (independent from Irish Life and from your employer) who will be aware of the specifics of your policy and should be able to help you with how best to proceed with your claim.

Often this will be the same contact that sends you your Pension Statements...

All the best with your claim and recovery.

ravima · 12-11-2012 06:40PM

Azures - I don't work for Irish Life.

Its just that the aim, I presume, is to return to work, if at all possible, rather than simply give in to the illness and allow it to take over. That would be my thinking anyway.

amdublin · 14-11-2012 08:40AM

Azures wrote: »

Irish life policies should support that aim- but in reality they don't. If it looks like you need to change jobs, or are not going to recover, they get a doctor in the panel to write a false report then make you go through their secret appeals process- and no one ever wins an appeal. It is not honest and honest people who want to return to work are punished

That's one hell of an allegation you are making there. Do you have any stats or data to back this allegation up?

BuffyBot · 14-11-2012 11:15AM

Indeed, please substantiate or withdraw. If you can't do the latter, than don't post such things.

tony81 · 15-11-2012 10:15AM

Depression is a shady area for I.P claims. I.P pays a large percentage of your salary so naturally an invisible illness like depression that has no clear prognosis is hard for them to swallow.

Irish Life fund a mental health rehabilitation program. Ask I.L if it's in your policy and can you claim for it.

BuffyBot · 15-11-2012 11:01AM

Personal anecdote does not equate to evidence. In future, please do not use this forum to bandy about unsubstantiated claims.

Henry Ford III · 15-11-2012 11:47AM

Azures wrote: »

Pages of emails letters etc- if they want to proove me wrong...it is pure personal experience, qualitative data, not quanitative. They do not release their refusal stats as far as I can figure out. If people find it offensive that I have told a personal anecdote and expressed it in emotive terms then I withdraw what I said, but I didn't know what the process was when I took the policy out. I thought I would be okay if I ever needed the policy.
Moperator, please delete the comment.

ILAC have no legal nor moral obligation to release stats on declined PHI claims.

Did you take the legal route after declinature? If so what was the outcome?

Azures · 15-11-2012 10:23PM

BuffyBot wrote: »

Personal anecdote does not equate to evidence. In future, please do not use this forum to bandy about unsubstantiated claims.

I understood what you said the first time moderator- I asked you to delete the comment. Qualitative data is valid evidence. It is raw data.

Henry Ford III wrote: »

ILAC have no legal nor moral obligation to release stats on declined PHI claims.

Did you take the legal route after declinature? If so what was the outcome?

Declinature? You work for one if these companies also?
I have no intention of saying anymore personal anecdotes, in case I get another telling off. I did seek legal advice, what else can a person do?

Azures wrote: »

I was sent to see a dodgy doctor by an illness protection company - his report never mentioned my job - but the claims still cancelled my claim, I've sent 5-6 reports all opposing their doctors view, not only did they hold an appeal meeting which I was not allowed to be represented at , but they refused to show me the written decision for the original decision or the appeal, I'm still on leave, 6 months after their doc said I was fit to work , I have no money and the company have restarted the policy charges, I have no money to pay it, and no way of ever making a claim on the policy now as I am not working, but if I cancel it I can't appeal to the ombudsman either. I am getting into serious debt because of them. They only care about getting out of the policy contract. They are immoral. They also will not reply to my letters. Be warned- they are unaccountable, all powerful, and if they can get a doctor to write a report to stop your claim, they will and there is no appeal system in reality- just secrecy and disrespect for the customers who pay their salaries.

For the record I have tried to withdraw this comment for fear of legal action, but I cannot do so. I sincerely apologise and withdraw any criticism of Irish Life, they treat their customers very well and are very concerned to achieve the correct outcome and do not refuse clients in desperate need who still fulfil the policy criteria and their appeal process is very clear and very open. I'm sorry I expressed a personal experience on Boards. There. Everyone happy now?

BuffyBot · 16-11-2012 10:31AM

Yes, it's data. But not sufficent or substantiated.

There is no reason to delete the post and we're under no obligation to do so. It allows others to evaluate your contributions to the topic in hand. Speaking of which, let's put the thread back on topic.

tony81 · 16-11-2012 11:10AM

Azures wrote: »

For the record I have tried to withdraw this comment for fear of legal action, but I cannot do so. I sincerely apologise and withdraw any criticism of Irish Life, they treat their customers very well and are very concerned to achieve the correct outcome and do not refuse clients in desperate need who still fulfil the policy criteria and their appeal process is very clear and very open. I'm sorry I expressed a personal experience on Boards. There. Everyone happy now?

Azures, you cannot be serious? You just mentioned the name of the company! They're coming for you....

Anyway you're misinformed. If your claim was denied you can write a letter of complaint. Irish Life will investigate it internally. If they disagree with your complaint they will provide you with a sign off letter to take your complaint to the financial services ombudsman, who basically will have the final say.

Henry Ford III · 16-11-2012 12:50PM

Azures wrote: »

...Declinature? You work for one if these companies also?

No but it's the correct term I think.

Irish Life declined my Income Protection claim - how to successfully appeal ?

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