Need advice. Insurance company taking away my income. Read MOD note Post 35

imokyrok · 16-06-2011 10:31am #1

I've had Fibromyalgia/ME for twenty years and eight years ago I became too ill to continue my career and had to give up my job. I was eligible for payment under my companies Income Protection insurance with <insurance company>. It wasn't much money as I'd already gone part time in order to try to cope with my illness but it paid my mortgage.

Over the years since, <insurance company> has regurally sent me for different medical assessments and all doctors agreed I was unfit for work. This summer they finally managed to find a doctor who obviously doesn't believe in 'invisible' conditions like Fibromyalgia and ME and has declared me fit for work despite the fact that nothing has changed in my condition. <Insurance company> will be cancelling my income and I need to appeal this decision and my pain consultant will support me in this.

Through the ME grapevine I've heard they are doing the same to many who have been assessed by this particular doctor. Im looking for tips on dealing with the appeal and also wondering if anyone can suggest a solicitor who would have the interest and experience in fighting Insurance companies on behalf of patients like me. I need to get a successful appeal through as fast as possible and so if anyone has any advice for me I be very grateful.

skippy2 · 12-08-2011 10:08am

All i can say is fight them. I had a bit of a fight with my Insurance company also through Income protection Policy through work for a different condition. Maybe get your company doctor to assess you because the company cannot let you back to work until certified by a doctor, "their doctor" as "fit for work" so that might be worth a try.

Do not let them win on this one as they will do anything to avoid paying. Also threaten them with going to the Financial Services Ombudsman if they do remove your payments. Keep all documentation and do everything in email/writing

imokyrok · 07-09-2011 8:49pm

skippy2 wrote: »

All i can say is fight them. I had a bit of a fight with my Insurance company also through Income protection Policy through work for a different condition. Maybe get your company doctor to assess you because the company cannot let you back to work until certified by a doctor, "their doctor" as "fit for work" so that might be worth a try.

Do not let them win on this one as they will do anything to avoid paying. Also threaten them with going to the Financial Services Ombudsman if they do remove your payments. Keep all documentation and do everything in email/writing

Thanks for your post. My consultant ( who has scheduled me for surgery later in the month) sent them a blistering letter and they decided to get a third opinion. I attended that third 'opinion' today - a neurologist who informed me he wasn't interested in seeing fibromyalgia patients. I will keep fighting. The financial ombudsman will be hearing form me shortly if this appeal goes against me. Might even give Uncle Joe a shout!

dinelli · 10-10-2011 7:36pm

How did you get on with your fight against the insurance company?

I'm going through a similar situation at the moment and it's not looking good for me

SerialComplaint · 11-10-2011 9:21am

Why don't y'all give David Norris a call? He seems to be expert at getting insurance companies to pay out on disability.

mags1076 · 13-10-2011 10:44pm

Im in the same situation with <insurance company> I have chronic Fatigue just been told they will stop my payments shortly after attending a medical assesement in September. I had to visit a doctor in <location>. Am in total shock as would love to go back to work but am exhausted all the time dont know what Im going to do. Dont even know where to start with my appeal its too tiring to think about.

mags1076 · 13-10-2011 10:45pm

Any update on your appeal?

maryjune · 18-10-2011 10:01pm

Hi there,

First time posting here so hope I am doing it right.
I am in a similar situation to yourselves. I have Income Protection with <insurance company> and have been to see two of their doctors at this stage.

Of course and surprise, surprise, they are refusing to acknowledge the severity of my Fibromyalgia.
I think we should name the doctors who are making these decisions for <insurance company>
I wonder if it would be beneficial for us if we could establish whether they are more or less medically qualified with regard to Fibromyalgia than the consultant rheumatologists that have diagnosed and are treating us.

Theyse doctors are affecting the lives of people who have enough to contend with because of Fibromyalgia and Chronic Fatigue.They are adding to their distress by recommending the cutting off of their payments.

What happened to "First do no harm" in the medical profession.

I understand that there are people who make false insurance claims but when it is supported by doctor and consultant reports I don't understand why <insurance company> do not wish to accept this. They were quick enough to accept our money when we took out the policies.

Anyway, please let us know how ye get on and I will do the same

skippy2 · 18-10-2011 11:56pm

Would a stiffly written letter from your consultants/doctors asking <insurance company> directly are they calling them liars because that seems to be the upshot of it if they do not take the word of a consultant.

maryjune · 19-10-2011 12:01am

I guess it should be of some help but would consultants be willing to take the time to write such a letter for us? I asked my GP to write a comprehensive letter outlining all my symptoms and all she managed to do was write a note stating I was suffering from Fibromyalgia and in her opinion currently unfit for work. Obviously this was of no help. I

mags1076 · 19-10-2011 3:58pm

I now have to return to my consultant to get him to write a letter for me as you say Skippy2 the consultant is far more qualified to make this diagnosis than some doctor who for me obviously didnt listen to a word I had said and only checked my height and weight and then made this great diagnosis that yes I did have chronic fatigue but could go back to work in 3-4 weeks time!!! One other interesting thing is that it seems to be that <insurance company> send us all to the same clinic for this wonderful Doctor to say we are fine to return to work I wonder if is because its almost a fore gone conclusion what the report will be. Strange we are all miracally cured of our ailments just by the Doctors at this clininc.

maryjune · 19-10-2011 6:01pm

Obviously the doctors that do assessments for <insurance company> have healing hands because as you say Mags, we are miraculously cured when we go to see them.

Is it a waste of time, money and resources to be attending GP's, Rheumatologists and other medical professionals when all people like us need do is ask <insurance company> to sent us to their medical assessors whereby we are miraculously cured in one quick consultation.

imokyrok · 20-10-2011 8:58pm

Good news folks. My appeal was successful. I'm still in shock!. As I said before my consultant wrote a stiffly worded letter to <insurance company> on my behalf. They then said I had to go to yet another consultant of their choice. So they sent me to see a neurologist. That neurologist was pretty unpleasant on the day and indeed he said to me that "most neurologists don't believe in fibromyalgia" When I pointed out that neurologists in the US are the main consultants for treating FM he said "well I've no interest in treating fibromyalgia patients". Talk about dismissive.

The only symptoms he was interested in hearing about were my migraines which are very severe and frequent - (common in people with fibromyalgia). I made sure to document the entire conversation as soon as I left the surgery and wrote to <insurance company> about the matter. Anyway in the end I got word that my appeal had been granted.

With regard to that doctor in <location> I think <doctor> is a disgrace and obviously hasn't kept up to date with research in ME and FM. <Doctor> quoted papers and a book long out of date in <doctor's> report (and a book that was considered an outlier even in it's day). <Doctor> also used the wrong diagnostic terminology to describe <snip> findings during the physical exam - which was the most cursory physical exam I've ever received. <Doctor> just doesn't believe in the conditions. <Doctor> said in her report that I'd made no effort to return to work. - This despite knowing I had had 5 nerve block procedures under general anaesthetic in the last two years and am now scheduled for the implantation of electrodes to try to decrease my pain and improve my quality of life. If that's not trying to overcome a condition I don't know what is.

My consultant read <the> report and said and I quote "<Doctor> writes the same bloody report for everyone , the clown". So <doctor is> obviously well known for being an <insurance company? stooge. I'm thinking of making a formal complaint to the medical council. I keep thinking of all the people who are too stressed out or otherwise unable to fight these people and left poverty stricken despite having paid their premiums.

maryjune · 27-11-2011 2:41pm

I am so glad for you that you have won your appeal. Well done you!

AnnaStezia · 27-11-2011 9:25pm

The way that you have been treated was disgraceful. I am glad that you won your point.
A formal complaint to the financial regulator might be a good idea.

imokyrok · 28-11-2011 1:12pm

Sadly Annastesia I'm just one of many of the <insurance company> dependent patients in the Fibro/ME/CFS community being impacted by their latest hired gun. Hard to know what's the best thing to do since we have no access to advocates on our behalf. But I'd definitely advise people to fight- all the way to the courts if necessary. <Doctor's> 'expertise' wouldn't stand a chance in a court up against a qualified rheumatologist or Pain Consutant etc imo.

I'm currently recovering from surgery to having had the spinal cord implant so it will be a while before I'm in a place to think about what's next. I wish some organisation was available that would be willing to go to bat for us all- I know how hard it is for sick people to maintain the momentum to fight a large company like that. I'm told that most give up at the first hurdle and that is what <insurance company> depends on happening.

When you say financial regulator - do you mean the insurance ombudsman. I don't really know about such things.

michaela 56 · 19-06-2012 3:13pm

I have chronic fatigue since 2003 but continued to work. In 2008 I was diagnoised with fibromyalgia.I also have ibs,asthma,hiatus,depression,sinus. Since I developed the fm it became impossible to work and to cut a story short I was retired from work on grounds of ill health in 2010. <insurance company> continue to review me regularly.So far I have been to 3 Rheumatologists and they have called to my home 3times. Also I have had an CPAD assessment which is carried out over 2days and lasts 3hours both days. I am wiped out completely by all this. Basically they want to find a lope hole to stop my payment.
Just wondering has anybody experienced this form of intimidation / bullying and would appreciate any help /ideas you may have.
I am too tired to fight on.

michaela 56 · 21-06-2012 11:25pm

Has anyone out there had a CPAD assessment with <insurance company>

Graces7 · 30-07-2012 1:44pm

My heart goes out to you all re this.

I was misdiagnised in the UK for three decades. As mentally ill; and bucket diagnoses eg personality disorder. The system there is different of course, or was then and the abusive drs were quite happy to sign me off. EVenw hen I was wheelchair bound, I had the same kind of degrading and draining fight for mobility allowance; the same kind of disbelief and what I can only call corruption that so many of you are facing., I was in rental accommodation and after the three months on full pay ( teaching) went on to disability.

At every turn I was blacklisted by the drs; the only time I had a fair hearing on a home visit was from a dr new to the area who had not yet heard my "reputation". I was then awarded mobility for life.

At no time was there ever any understanding of my illness and it was only some 15 years ago that I learned the truth, from a single mention by a consultant and then the internet. ie M.E. Then a good dr and a proper case history and a note on my medical records, that I was never mentally ill but it was always M.E
I left the UK then for ever. So much corruption.

Yet I learned that I exchanged one illness that was clearly ( !) my faulty, for another that was not always believed in; yet even so here in Ireland atttitudes are better on the whole. I turned 60 and qualified for retirement pension was to shed a great burden. No one can challenge my income now.

And yes. fight them on this, but take care of your needs first. I did not always do that Do not let them grind you down as they did me.

It has all left me with a deep distrust of drs, and I never see the one am registered with here, I get repeat prescriptions by post after explaining by letter that getting to see her would be too stressful etc. I question and research any meds etc myself.

michaela; I have all the problems that you have.

Sorry ; I do not understand the Irish system; can you not go on to disability and mortgage relief etc, if IL does their worst?

the_syco · 13-08-2012 3:02pm

imokyrok wrote: »

My consultant read her report and said and I quote "She writes the same bloody report for everyone , the clown". So she's obviously well known for being an IL stooge. I'm thinking of making a formal complaint to the medical council.

PM each other to confirm the name of the doc (don't think boards.ie mods would be comfortable naming any doc in public), and if it is the same doc, complaint to the Medical Council.

If all of we write a letter of complaint about the doc, and enclose the letter that the doc gave to you, maybe the doc's license would get revoked for malpractice?

Casey53 · 17-08-2012 3:10pm

Am a suffer of fibromyalgia and have just lost appeal with <insurance company>. Had CPAD assessment - the report practically called me a liar!! Also attended the doctor in <location> - requested by <insurance company>. <Doctor> maintains I'm fit to return to work after just talking to me for less than half an hour!! The stress and anxiety being placed on people by <insurance company> is unacceptable and soul destroying. I've taking advice and am in the process of writing to <insurance company> asking them to reconsider this unjust decision.

michaela 56 · 23-08-2012 9:07am

same old story as you all. my payment stopped and have to appeal. Am so exhausted don't have energy to fight them. Doctor in <location> basically said I was in full health and for me to return to work. All these doctors are on the side of <insurance company> so it doesn't matter what we say as they don't want to believe us. Amazing the way all their doctors have healing hands and undermining my own consultant / dr. Its bizarre the whole thing and disgrace <insurance company> get away with it.

snap2012 · 29-08-2012 3:38pm

Hi all, I'm in the same situation. I visited this <insurance company> doctor in <location> for half an hour and <doctor> has denied my insurance claim. To make things even better I found out that they never used any information from my rheumatologist in their decision. I have been suffering with fibro for years and continued to go to work when I was in extreme pain and fatigue all the time. So now I am in an appeal situation and am scared that the appeal will fall on deaf ears. Arrggghhhh, this is so stressful. I cannot believe this is allowed to happen. Even if they do change their decision I'm afraid that they will haunt me for as long as it takes to get me off their books. We pay <insurance company> a lot of money for the peace of mind knowing that if we ever get sick we will still have some sort of income to survive. This is how we're treated. Crazy... If there is a letter to the Ombudsman let me know, I'm in.

Azures · 05-10-2012 10:57am

I also had my appeal denied after a secret appeal hearing by <insurance company>. I sent them 4 independent reports which contradicted their doctor and they still used their doctors to deny my claim on appeal. I still don't know the contents of their appeal medical report or any reasons for their refusal. All I received was a standard five line refusal email.
I am making a medical council complaint against the first doctor's report and I am taking legal arbitration. I wonder what percentage of reviews and appeals are denied? It is like America, deny deny deny every claim. I don't think anyone should walk away after having their claim illegitimately withdrawn, but should take it to the ombudsman and arbitration. <Insurance company> should give this information when they deny the claim, which they did nor give me. they are getting away with destroying lives and not following the law and regulations. I have a physical disability.

pjmmoriarty · 05-10-2012 3:22pm

Hey Guys and Gals, Hurt my back at work been out for 10 months now,Income protection insurance by <insurance company>, Been seen by <insurance company> doc , my own doc and i am out until at least next may and both sent in reports to <insurance company> . They said there was insufficent info in them and now they want to send an assessor to my home for a 3 hour assessment . Its been nearly 5 months waiting for them to make a decission to pay or now. Its not that much money and between the pain, stress and depression , I feel like jumping out a window. But I never heard of an assessment being done in your own home. I have to use a walking stick at times and the other furnature to help me balance.
My question is has any one had to have one of these assessors come you your home before for assessment.

Kind regards

PJ

Azures · 06-10-2012 2:41pm

They have sent someone to me at home twice, 'a nice little chat,' it seemed pretty pointless but Im sure they were up to some sort of information gathering. Tell the truth but don't expand too much on your answers! It's at your home so you can set the agenda.

warrior2012 · 06-12-2012 2:43am

Hi All
I suffer from depression and anxiety and <insurance company> declined my Income Protection claim. I am waiting for the report from my consultant to appeal.

1) Did you send your appeal to <insurance company> on your own or you asked a solicitor for help?
(Somebody gave me advise that I should find solicitor but I am not sure if it makes any sense at this stage.)

2) Did you send to <insurance company> any other documents than the specialist report?

thanks

connber · 11-02-2013 9:19pm

Hi All,
These stories are just like mine. I am being sent for a CPAD. They are waiting to get a practitioner from the UK to administer it . I have appealed their decision to deny me my Income Protection which ceased on Jan 1st. I attended their well known doctor in <location>. He was out of order during my examination and I complained. I reckon that's the only reason that they didn't turn down the appeal.But they will. Does anyone know what this CPAD entails?. Also has anyone ever had a successful outcome from the Ombudsman?
I would also appreciate if anyone knows a solicitor who has an interest in defending Fibromyalgis/CFS patients. I also have very severe osteoporosis.
Thanks

Geri Fennelly · 26-02-2013 11:02pm

I'm in same boat but further down the line and on route to ombusman.

connber · 27-02-2013 12:02pm

Geri Fennelly wrote: »

I'm in same boat but further down the line and on route to ombusman.

Sorry to hear it has gone that far. Still think that this needs to be highlighted as it seems to be a divide and conquer strategy on the part of <insurance company>. It will require action by a group to halt this treatment.it is so sad to see so many exhausted people having to fight for their rights

the culture of deference · 10-05-2013 1:59pm

did the <location> doctor work here

If you wish to make a complaint about a doctor, please contact the Medical Council rather than posting names here. Thank you.

connber · 11-05-2013 1:28pm

I have an appointment with this person. Any advice/

the culture of deference · 22-05-2013 9:44am

connber wrote: »

I have an appointment with this person. Any advice/

is it the <doctor>?, your appointment will be for X time, <doctor> will be seeing you for 25mins, your ins co. will get a 12 line report in 4 weeks.

connber · 24-06-2013 11:50pm

Attended as stated. Was turned down. Does anyone have a positive result from ombudsman?

Boards.ie: Niamh · 26-09-2013 12:28pm

MOD note:
I have tidied up this thread to edit any comments that may identify an insurance company or doctor. Please be careful not to issue any identifying info in any further posts, i.e. location, name of insurance company or name of doctor.

Thank you,
Niamh.

anothrkrok · 28-01-2014 1:58pm

I have been treated likewise re income protection,by insurance co. with their hired docs.disgraceful.Am fighting back as draining as it is! would like2 hear from Niamh or akrock or anyone in in a similar situation!

anothrkrok · 29-01-2014 9:02pm

nice to hear from you. terrible treatment, when one is at their weakest bt outfits that advertertise themselves as caring! it is well known about these hired doc holidays! they should be named and shamed.Rgds akrok

w2darren · 30-01-2014 3:20pm

I also have had my I-P Stopped from an Irish insurance company, i am just awaiting the final decision from the ombudsman, ( it,s at the last last process which should take about 6 to 9 weeks) the whole process, from the internal appeal to date has taken 14 months. YOU must fight it if you are genuine.

I am still in shock that the insurance company independent consultants, stated that i was fit to return to my normal occupation.
I don't think it matters that my own consultant stated otherwise,
I think the insurance companies want to weed out the bad and if that means that some genuine are also weeded out well all the better for the insurance companies, but not for us.
You just have to try to cope with the stress and remember it takes a while.
So once you have tried the internal appeal process, you should go to the Ombudsman.
best of luck

anothrkrok · 30-01-2014 11:17pm

Am in the same situation. have you had any luck! Rgds amakrok

w2darren · 31-01-2014 10:49am

Hi anothrkrok,

as i have said i am awaiting to hear from the Ombudsman, this is the final stage and it could take anything from 6 to 9 weeks, but these are just guide lines, depending how complex the case is.
best of luck yourself

snorlax · 06-02-2014 9:46am

Would it be worth checking if the doctors are mis-diagosing people are properly registered with the irish medical council and maybe to write to them about the case with the support of a consultant who has diagnosed the condition. Doctors like any other health profession are supposed to follow standards of care.

Boronia · 28-03-2014 9:06am

What a depressingly real thread for someone about to start into the process.....I have my phone interview with a nurse in the UK today. I also have Fibromyalgia. Still it's better to be forewarned that it may be a battle to get what I am entitled to under a scheme that I joined and have paid into for many years. I hope some of you have successful outcomes.

Bear13 · 27-05-2014 1:09pm

Hi Guys,
Just wondering if any of you got sorted?
I have been off work for nearly 9 months, but my Income Protection was only due to kick in from 2nd March as my employer paid me full pay till then.
I suffer from adhesions, chronic pain, fibromyalgia, migraines and a weakness in my right leg. My husband is my full time career but also has to work full time so we can keep a roof over our heads.
As he earns just enough, it means we earn too much so I am not entitled to home help or anything apart from illness benefit.
Though my employer's doctor along with my own GP and consultants have all confirmed that I am unfit to return to work indefinitely, I had a 2nd medical for ICP on Monday 19th May.
I would greatly appreciate any info you have that will help me understand the delay.
Many Thanks

Liam D Ferguson · 27-05-2014 2:51pm

Hi Bear13,

I got your PM. I can't really comment about your specific case without knowing the full background and seeing the full file. All I know is what you have PMed and what you've posted here.

In this instance, it seems you have Income Protection cover through your employer. Is it an individual policy that you bought yourself or a group scheme? The broker for the Income Protection scheme or policy should be helping you with your claim. Put the following questions to the broker...

When does s/he expect this claim to be paid?
Are there any exclusions on your cover?

If your illness is not excluded from your policy and it renders you unable to work, then the claim should be paid.

Boronia · 09-06-2014 5:45pm

Hi all...well my Salary Protection claim was "Denied" and I am appealing..anyone had success going through a solicitor?

Liam D Ferguson · 10-06-2014 7:50am

Boronia wrote: »

Hi all...well my Salary Protection claim was "Denied" and I am appealing..anyone had success going through a solicitor?

Sorry to hear it. What was the reason given for the denial?

Boronia · 10-06-2014 8:58am

Hi Liam,
I dont have it in writing yet from the company but they denied it over the phone and the reason they gave was that my Medical Evidence "was not strong enough".

I have requested a copy of the Medical reports (from my Consultant and their Independent Medical Specialist) which they say will come to my Doctor this week. I had been reading about a High Court Case that was won against an Insurance Company this year by a person who also has a diagnosis of Fibromyalgia and I thought maybe a solicitors letter may aid the strength of my case.

Liam D Ferguson · 10-06-2014 9:32am

That's certainly disappointing. If you are not capable of working due to your illness, then the claim should be paid. Is there a broker involved? If so, have you contacted the broker to help fight your case? It might be an alternative prior to incurring the expense of a solicitor.

Boronia · 10-06-2014 9:52am

I have only dealt with the brokers so far, apart from a telephone interview. It may be worth me ringing them to ask will they help me to fight it and see what they say. I will PM you.

skippy2 · 14-06-2014 12:05pm

If your consultant deems you unfit for work and they try to overrule it. Get your consultant to send them a stiff letter asking them are they calling him/her a liar and are they questioning his/her professionalism. Their so called independent consultants are far from independent as a lot of people are finding out

If you're consultant deems you unfit for work as far as i am aware no employer can accept you back to work until you are deemed fit to do so

Cathalniamh · 23-02-2015 2:03am

hi there I have been out of work for last 12 months and received a diagnosis of fibromyalgia just this week.a gp in passage cork diagnosed me.i have two questions
1 can somebody recommend a consultant who specialises in this area,I have seen a neurologist and a rheumatologist who skirted around fibromyalgia but did not want to rubber stamp it.private message me if it is not allowed to name actual persons
2 can I claim on my illness protection insurance even though I have been out of work for a year alllready.
This past year has been disaster scans,mri scans,2 nerve blocks,2 sacroiliac joint blocks and epidural,never mind all the combinations of medication that does not work.i am starting a new therapy with Dr in passage cork which involves quantum integrative medicine.it sounds bonkers but frankly after 20 years of constant pain and finally getting a definitive name for my condition I will do whatever it takes to be me again.sorry for ramble ,all suggestions and help appreciated.

Need advice. Insurance company taking away my income. **Read MOD note Post 35**

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Need advice. Insurance company taking away my income. Read MOD note Post 35