Question
I am thinking about a Permanent Health Insurance policy. What can you tell me about them?
Answer
- IPI (also known as Permanent Health Insurance) can pay you a regular income (and/or a lump sum) if you are unable to work because of sickness or disability. The income would normally continue until you are able to return to paid work or you retire.
- People with ME/CFS can experience a variety of problems when it comes to IPI claims. Not surprisingly, we receive anecdotal reports indicating that some companies are not sympathetic, or are even hostile, to claims relating to this illness.
- Overall, we receive very little feedback about problems with the initial claim – in most cases this is accepted provided a firm diagnosis of ME/CFS or PVFS has been made and you are clearly unable to complete paid work.
- Problems can arise once the claim has been going for a period of time – often as a result of a further medical or occupational health assessment – and you might be pressured into doing, regular exercise, for example. However, the National Institute for Health and Care Excellence published a new Guideline on ME/CFS in October 2021:
- This is a framework of evidence-based recommendations to the NHS and social care providers.
- Any insurance company or appointed medical representative should be familiar with the Guideline – and should bear in mind that Graded Exercise Therapy (GET), for example, is no longer considered appropriate.
- The insurer might also come to the conclusion that you are now fit to return to work as a result of a subjective functional assessment, even though you and your doctor do not agree:
- RWK Goodman solicitors has an expert team available (see below) for IPI claims relating to ME/CFS or Fibromyalgia, for example. They advise that:
- if during the period when your claim is being reviewed you are asked to attend an assessment, you seek advice beforehand, take someone with you, and avoid any home assessment unless absolutely necessary.
- the GMC Good Practice Guidelines (2013), state that the doctor should have expertise in the condition and should not leave out any relevant material.
- you take great care and always attach a more detailed schedule to any Activity Questionnaire you receive as they are normally space limited.
- insurers also actively use surveillance and monitor social media
Things to consider about PHI.
- The amount of income you are allowed to claim will not replace the exact amount of money you were earning before you had to stop work.
- You can expect to receive about a half to two-thirds of your earnings before tax from your normal job. This is because some money will be taken off for the state benefits you can claim, and also the income you get from the policy is tax free.
- You can’t claim income protection payments straightaway if you fall ill or become disabled. You usually have to wait a minimum of 4 weeks, but payments can start up to 2 years after you stop work. This is because you may not need the money straightaway as you may get sick pay from your employer, or you may be able to claim statutory sick pay for up to 28 weeks after you stop work.
- There are other types of illness insurance you can take out such as critical illness insurance. You should compare income protection insurance with other types of illness insurance before you decide whether to buy it.
- check
- that you don’t get IPI through your employer.
- to see if you have some kind of illness insurance combined with another insurance policy or with your mortgage that covers you for serious illness.
- that you have sufficient income to cover the cost of premiums – you won’t get any money back if you never make a claim.
- if PHI is the right insurance for your needs and consider taking independent financial advice.
- the terms and conditions of any policy very carefully before signing to ensure it meets all your needs.
- to see if there are any exclusions to the type of illness covered. You may not be covered for ‘pre-existing conditions’ i.e., conditions that you or a family member has had before or currently has.
- that you will be covered if you change jobs.
- It is possible to find an insurer who will provide a policy that covers pre-existing conditions, but the premiums are likely to be higher.
- The period between a claim being made and the policy paying out normally takes 4 weeks but can be delayed longer depending on the assessment process.
- When taking out a policy you can intentionally delay the payment which might make premiums cheaper.
Source:
Citizens Advice: Income Protection Insurance.
More information
- The ME Association has worked with RWK Goodman solicitors who have a team that can help if you are experiencing any problems with an IPI claim relating to ME/CFS or Fibromyalgia, for example.
- They have an expert team who can liaise with the insurance provider and your employer should you encounter difficulties making a claim, with medical assessments, or if your claim is denied or terminated.
- If you decide to seek professional advice from RWK Goodman, or any other firm of solicitors, it is best to do so as early as possible. Fees will be involved, so ensure you can afford them before entering into any service agreement.
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MEDICAL DISCLAIMER
Information provided by The ME Association should not be construed as medical advice. Don't assume any new or worsened symptoms are simply the result of having ME/CFS or Long Covid. We recommend that any information you deem relevant is discussed with your NHS GP as soon as possible. It is important that you seek personalised medical advice from the GP who is in charge of your care and who knows you well.