Critical illness insurance claim

[greyshadows]

I've been on long term sick due to a v bad flare of fibromyalgia. I was advised by occupational health and HR to file a claim with Critical Illness insurance provided by my employer as I could potentially get some income that way once sick leave ended.

I had a look through the brochure and it looked like it wouldn't cover fibromyalgia but I went ahead and filed the claim anyway

Please note both my manager and Oc Health have been supportive.

The insurance claim has come back - denied (fine, expected really) but I'm so upset because they've said that overall the evidence doesn't support that I've been absent due to a medical condition that would prevent me from working during the assessment period. I'm fuming and so upset as I feel it makes it sound like they are accusing me of skiving basically.

They refer to the reason for me being off as "pain" instead of fibromyalgia (pain is just one aspect of fibro) and also mention that I did see a private consultant for pain and all results came back normal (the rheumatologist basically confirmed my feeling that it's a bad flare up of fibromyalgia and only time will help but did so some blood tests to rule out anything else).

My GP had obviously been writing me sick lines but the letter also notes I've not raised pain or any other symptoms with my GP since September. This is rubbish as although the GP who knows me v well and was handling my case went off sick herself around September, I've spoken to other GP's/ Advanced nurse practitioner. Not as regularly as my own GP I admit, but this was because I'd had the second opinion from the rheumatologist that it is indeed a fibromyalgia flare up.

Just after the assessment period mentioned, I've had a chronic fatigue / M.E diagnosis too.

I'm also worried now that Occupational health and my manager will take this report into account and believe that I've been faking sickness but perhaps that's me running away with myself 😥 it's just so much stress to be poorly and then have to fight your own corner as well

Any thoughts and opinions welcome but please be kind, it's been an incredibly tough 14 months.

Bump

If your employer has been supportive, I'm sure they will continue to do so. It isn't uncommon for an employee to be too ill to work, but still be refused critical illness. Whenever I discuss critical illness type applications with employees, I always tell them that the decision isn't made by the employer an whilst we will support the application as best we can, the decision is made by the medical professionals who manage the scheme, not us.

If you think the decision is incorrect, could you appeal? Based on what you have said about fibro. nor being covered, it may not worth it, but if there are other things that you believe weren't being considered, it may be worth it.

With regards to the critical illness scheme, they will be working with strict criteria to make assessments and unfortunately many illnesses don't fit neatly into their boxes. It doesn't mean that they or anyone else thinks you are skiving, it just means that it doesn't meet the criteria. They often use language specific to the scheme and can feel very inhumane.

Can you apply for any ill health benefits?

@purpledagger thank you so much for replying.

I think everything you've said makes sense. I was just very upset by the wording. Appreciate your input

Critical illness policies are notorious for not being as useful as hoped. I pay a fortune for mine and the list of illness are strictly prescribed (think loss of a foot). Read the policy closely if you consider they've made an error then complain and you can then take to the Ombudsman.

We’ve had to fight for 6 years to get my DH’s critical illness to pay out - they have finally just agreed that his brain tumour is covered in the policy 🙄🙄

basically they want your money every month but will look for any possible excuse not to pay.