ME, also known as chronic fatigue syndrome, is a recognised illness. However, some of the big health insurers see it quite differently, as the case of Miss A demonstrates. Miss A has been living with ME for eight years, an aggressive form which has kept her wracked with pain and completely unable to work and support herself. Living on benefits totalling '180 a week, she depends on her boyfriend and family to look after her. It could have been very different, because Miss A had permanent health insurance through her employer. The insurer is Swiss Life, and although they did pay out on her claim at first, they decided to stop paying out five years ago. On the terms of the insurance policy, she was receiving a regular income amounting to 75% of her salarythen it stopped, and since then, she has received nothing. She estimates that she is already been denied access to '40,000. So what has Swiss Life got to say on the matter? It's not so much what they said, but what they DID, that is the real eye opener. Showing a distinct lack of respect for the debilitating illness, they used covert video surveillance to track her movements and gather evidence to prove that she was not worthy to make the claim. They have used footage of Miss A leaving the house to attend a medical appointment, and then going to visit her Mum, to suggest that she would be perfectly capable of doing a day's work. This is a view that medical experts have soundly rubbished, especially as ME can vary from day to day, leaving sufferers able to perform small tasks one day, and then consigned to bed the next. Video evidence showing Miss A on her feet would not ever convince a doctor, who knows all too well what effect ME has on people's lives, but Swiss Life has used the evidence as proof of her being 'active and mobile'. They also have other criticisms of Miss A which has enabled them to successfully deny her claim; for example, they say they have seen no long-term evidence of her inability to work. They also say that she resisted rehabilitative treatment back in 2002, when in actual fact Miss A was unable to complete the course because she suffered a relapse. Even a Harley Street doctor and ME specialist has examined Miss A and can verify that she is suffering from ME and is deserving of her health insurance payments. To no avail with Swiss Life. The only way that Miss A can win her case is to take it to the Financial Ombudsman, and they have already said that any compensation will be limited to a maximum of '100,000. Miss A is not willing to take the risk, and is distrustful of the Ombudsman. Who can blame her, when she has been treated so badly so far? Resolution, the owners of Swiss Life, says that they wouldn't stand in her way if she wanted to progress the case with the Ombudsman. The problem that Miss A is having is being experienced by many people with what insurers deem to be 'designer diseases'. The insurers think that people are trying to take them for a ride. The reality is that people are suffering, and they are not receiving the payout they are due. Those looking to buy a health insurance policy should be absolutely sure that the company has a good attitude towards diseases like ME, so if the worst does happen, you will be covered. Try the Internet for the cheapest prices, and for an extensive range of tips and advice. |
