Permanent Health Insurance - How would you proceed?

PHIclaim

Hi all,

I have been unable to work since September 2018 due to a bad relapse of my generalised anxiety disorder. My employment as a project manager in a large accountancy firm can be stressful, and did play a contributing factor in said relapse, but I have struggled with severe episodes of anxiety since 2012.

As I had already been absent from October 2017 to April 2017 (another anxiety episode), I had exhausted all of my sick pay by October 2018 and applied for universal credit (which I am being paid monthly). In November 2018, my employer made a surprising revelation and noted that due to my 5+ service at the company, I was eligible to claim under the company’s permanent health insurance. Although I was unaware this existed, I promptly asked HR to make a claim on my behalf.

Legal & General sent me a questionnaire which I completed and returned, in which I had to detail the core duties of my role and outline the symptoms experienced that meant I could not work. I promptly sent this back, along with letters from a private consultant psychiatrist I had being seeing. Legal & General asked me to fill a second questionnaire specific to generalised anxiety disorder and arranged a call between myself and their rehabilitation team. On the call I was honest in describing my symptoms, the detrimental impact on my ability to function, and informed them that I felt I would need to press for changes to my role in future to help curb the risk of future relapses as it could be stressful (although I also explained that I did enjoy the role and am well respected in my department).

To my surprise, L&G rejected the claim in January 2019, noting that based on the conversation with the rehabilitation specialist and the other evidence, they felt it was unlikely I’d continue to meet the definition of incapacity all the way to the end of the deferred period (March 2019) and should have been able to make a return to work by then, as long as the company made necessary changes to my role. My psychiatrist agreed that their decision was a little strange, as they had not considered my condition/prognosis in January and he noted that for individuals like myself, there is often a very drawn out process of improvement with no particular time frame. However, I took the decision on the chin and continued to further my recovery by attending counselling and trialling medication increases.

By March 2019, the deferred period had passed and although my condition had improved, it was clear to my psychiatrist, GP and Occupational Health, that I was not yet fit to start a phased return. I was still experiencing generalised anxiety and panic attacks, at a level which would not allow for proper occupational function and tolerance of the normal stressors of work. My psychiatrist was kind enough to write a letter to the insurance company, noting that I had experienced roughly a 60% reduction in symptom severity since our first appointment, but would be unfit for work for roughly another 3 months in his opinion, and would need to be phased into work with lower responsibilities. I also sent as evidence, 2 other letters from him from appointments in January and February, 2 reports from Occupational Health noting I was not fit for work, sick notes from the GP, a letter from my psychiatrist in 2012 (pre-employment) noting my severe anxiety episode, and a note from HR documenting a conversation we had in January 2019 in which we agreed on how to reduce the stress of my role when I do come back to work.

After almost an 8 week wait of radio silence, at the beginning of this month I received a letter from L&G, informing me that they needed more evidence and had written to my consultant psychiatrist. I contacted him and he confirmed that they had requested a medical report from him. We had a quick catch up about how I was doing, and then he completed it quickly and returned it to them. In the report (which I have a copy of), he notes that he does not know when I will achieve full remission and recommends roughly 3 more months of absence and treatment, before trialling a phased return. He also noted what type of things may cause a relapse upon my return, such as a busy, open plan working environment and tough deadlines.

I was very shocked when L&G responded 7 days later, noting that they needed further evidence and that they would like copies of my therapy notes from when I received counselling. I was not only shocked, but I was furious. I felt that I had provided them heaps of medical evidence from very qualified professionals and that they should be very able to make their decision, without rifling through therapy notes which could contain very personal or sensitive information.

I told HR how frustrated I was and they arranged for a same-day call between myself and case handler from L&G. I didn’t hold my punches during the call, and told them that after providing so much evidence already and waiting for months, that I did not see any good reason for them to request such private and sensitive information, which was not written by a medical professional (rather a CBT therapist). The case handler had no good answer for why L&G needed the information and danced around the topic for 40 minutes, before I told them we were going around in circles and agreed we should end the call. I called the Financial Obudsman to get advice, as I was super frustrated and upset at this point. The adviser agreed that based on the information already provided, it was surprising they really need therapy notes to come to a final decision, but suggested I obtain the necessary information from my therapist, review it, and provide it as I see fit.

Obtaining the information took a further 2 weeks, as the therapy notes had to be obtained via a subject access request from a large company for which my counsellor works as a contractor. I finally received the notes on Monday and reviewed them. They are very brief (one or two sentence notes) from each of my eight counselling sessions. As I had worried, they contained information I wasn’t happy to turn over, such as a sentence noting my Dad’s behaviour in my childhood may have contributed to my anxieties as an adult. Reluctantly I turned over the information and am now waiting until next Wednesday to hear back.

I apologise for such a long winded post, but I wanted to provide a crystal clear picture of what has happened so far and where the claim is at to date.

My question is, beyond hoping they will accept liability next week, what should I/could I do about my frustration with the process and what should I do if they reject my claim next or (in my opinion) worse yet, ask for even more information?

I am now much improved and am hoping to return to work within the next 8 weeks. The last thing I want is more stress to hinder my recovery, especially when it may not pay off financially.

Quentin

Whenever you are not happy with your insurance company the route to go down is a complaint in line with their complaints procedure

Then if you are not happy with the reply or they ignore you for 8 weeks you can escalate to the FOS for their adjudication at no cost to you

PHIclaim

Thanks for letting me know.

I’m not happy with the way they have proceeded with matters so far, but is worth me making a complaint now, or should I wait and see what their final decision?

What can I hope to get from complaining about their evidence collection process and what I feel to be unnecessary delays? Do they ever pay compensation?

Aretnap

If a final decision is (hopefully) imminent, personally I would wait until I had it before I made the complaint. It will be easier to write when you know whether you are complaining about the process, or the process and the decision.

You can complain about the way the claim was handled even if you eventually get the result you are looking for - the Ombudsman will award compensation where the insurer has unnecessarily caused a customer significant distress and inconvenience or other non-financial losses. Here's a page from their website - Googling 'Financial Ombudsman distress and inconvenience' will bring up others on the same theme

https://www.financial-ombudsman.org.uk/consumers/expect/compensation-non-financial-loss

Quentin

PHIclaim wrote: »

Thanks for letting me know.

I’m not happy with the way they have proceeded with matters so far, but is worth me making a complaint now, or should I wait and see what their final decision?

As the final decision may mean another complaint if it's not to your liking then there's no harm in sending your other one now - bearing in mind that the complaints procedure can take a long time you will at least have started one ball rolling.

If you ask for compensation and your complaint is upheld then insurers do pay it.

Firsttimebuyer26

Definitely do it

PHIclaim

Thanks for all of the helpful advice! I believe I’m due to get the next response in a few days, so I will wait and see what they say and take it from there.

Either way, I will complain about the process as they have dragged this out so much and have not been particularly helpful or reassuring along the way!