Chronic Fatigue Syndrome Insurance Claim
Mr H, CFS
Mr H had been employed as an IT manager for 9 years. Although he had previously been in good health, he started to develop a flu like illness. He felt tired, achey, and generally unwell. As time went by, his symptoms failed to improve significantly and he started to develop other symptoms including headaches, dizziness, disturbed sleep and poor concentration, memory and co-ordination. He was signed off by his doctor as being unfit for work. His doctor referred him to a specialist who diagnosed chronic fatigue syndrome.
Through his employer, Mr H had the benefit of a permanent health insurance policy that would pay two thirds of his salary and maintain his pension contributions were he to become unable to “undertake work of the type to which he was on the basis of education, training and experience, suited”. The insurers turned down his claim.
At that point Mr H instructed BLB Solicitors. Medical evidence was obtained from a consultant rheumatologist with a special interest in Chronic Fatigue Syndrome. The diagnosis of Chronic Fatigue Syndrome was confirmed and the consultant assessed its severity to be such as to prevent him from undertaking employment within the definition provided in the policy.
The insurance company did not accept the rheumatologist’s opinion and obtained a report from another consultant rheumatologist. Although confirming the diagnosis of Chronic Fatigue Syndrome, the insurance company’s rheumatologist disagreed with the Claimant’s rheumatologist as to the severity of the condition and its affect upon his ability to work.
However the two consultant rheumatologists were then requested to have a joint discussion for the purpose of preparing a joint statement setting out areas of agreement and disagreement between them. As a result of that discussion, the rheumatologist instructed by the insurance company altered his opinion and agreed with the Claimant’s rheumatologist.
Following that joint discussion, the insurance company agreed to pay the Claimant’s claim.
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