DW's firm & income protection insurance - ME/CFS

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Hello

DW is off sick with ME/Chronic Fatigue Syndrome. Her large global co offer income protection insurance as a benefit, the standard is 50% of salary but she paid more each month so it is 75% and kicks in after 1 year.

She attended a call with the insurance co's occupational health type ppl early Sept. The person on the phone's verbal conclusion was that DW was not fit for work, which matches what the GP says and the ME doctor we paid to see. She is waiting for the NHS fatigue clinic but this is v delayed due to CV-19.

We were expecting the next thing to be the insurance co confirming (or not) she is covered.

DW contacted work HR, as they will be told (as it is their policy). HR person not v helpful, reluctant to chase.

DW got her mentor involved, this resulted in HR person providing an update. Insurance co now want her to attend a physical exam of 2 long sessions, which will be really tough for someone with ME/CFS. But the earliest they can do is Dec, which is a couple of weeks after DW's money drops to 0%.

I am guessing there is nothing we can do other than wait & she attends the appt. We have been told if agreed they will backdate to the year.

I am just really annoyed that the employer is accepting of all of how long it is all taking with the insurance co - this started in March....I know HR are there to protect the org at the end of the day, but they also have a duty of care to DW I feel. And this is a benefit they offer, why offer it if you don't want your employees to access it.

If it is a "no" we'll have to downsize as we cannot live where we do on one salary, so it is a pretty big deal for us.

ME/CFS is often a misunderstood condition and there are cases online of insurance companies turning down claims, hence we are worried. There is also no real treatment for it apart from rest and hope you get better, so I can understand why the insurance co might not want to provide cover.

I personally feel that she should raise the length of this with HR, but she is finding this stressful as it is, so maybe she just needs to accept it.

Any thoughts? Thanks if you have read this far!

If it only kicks in after a year, and it's been ongoing since March then they still have 3 months after the appointment before they start paying.

I think at present everything is taking longer than usual with staff working from home and many people having been furloughed leaving far less staff to manage a workload so I would expect it to have taken longer than anticipated.

I hope your wife gets sorted quickly with it.

@Rockchick1984 - yes good points, I am sure CV-19 has had an impact.

It should kick in in Nov. The application process started in March, in order to be ready for her year off work in Nov. Sorry if that wasn't clear.

I cannot see anything wrong with the timing, it seems reasonable. If it only kicks in after a year, they need to do their assessments close to the time, no point doing it nine months in advance as the situation could change.

No one could or should assume that someone who is off work in March will still be off in November. The insurance aren't going to expend any time, energy or resources determining whether they have to pay out on the policy until the time comes when the person may be entitled to it. They will have been sitting on it rather than it taking too long. They will consider that the application process started far too early, I imagine - why is an organisation applying for the benefit 8 months before it may or may not be needed, they would say.

Frustrating for your wife, but an assessment a couple of weeks after she's had the absence criteria doesn't seem too horrendous to me, especially given the current situation. They've booked the appointment a few weeks before she gets to the year at least, which is something, and is quicker than I imagine lots of insurers would move.

'met' the absence criteria, not 'had'.

the timing is reasonable, they're not going to assess before you've even got to that year marker.

These timings are not out of the ordinary in normal times, let alone now.

I do hope she is in a union. They can help with chasing things up and with appealing if the decision is not in your favour.

Thanks everyone.

I think we naively assumed that a policy heavily promoted by her firm as in place from a year, would be just that. There will have been 3 months between the phone assessment and the in-person. We also don't know if there will be further requirements after this.

I think you can probably all appreciate the difference between 75% salary and 0% salary is significant. We have a London mortgage etc.

There are unfortunately documented cases (in general, not just from her firm) of ME sufferers being told they are fit for work when they are not, so we are concerned this is all leading up to this...

It is a very misunderstood condition, with no cure. A small % of ppl get better.

There is hope (although obvs it would be better if nobody had it) in the ME community that the swell of "long COVID" suffers, who will no doubt end up being diagnosed with ME, will finally bring some attention to it and help attract funding to help understand it.

Thanks again, perhaps we are worrying for nothing and this is just a normal timeline.

Best of luck OP. I have a family member and two close friends with the condition and it’s very tough, I know.