Sick Pay

[Meli96]

I’m in London. UK. I’ve been off sick for nearly 2 years. First 12 months fit note said stress at work, but changed to Post Covid syndrome (long Covid) Anxiety and depression thereafter. I have income protection as employee benefit but he didn’t help and it was declined (even the appeal). Tried raising grievance but HR declined to even discuss it. What options do I have for income whilst sick?
Sick note resets after 12 months but I haven’t worked in between the sick notes when reasons for illness changed.
Cant find help to prepare for ombudsman or even fight insurer, which my employer should be doing.
any ideas or suggestions appreciated

They don’t need to contact you. If you can’t return to work due to ill health you can expect that they will likely terminate your employment. Apply for PIP and ESA as suggested.

if you raised a grievance about the insurance company refusing your claim, your employer doesn’t have to deal with that.

Was your grievance about the insurance result?

Hello op, sorry about all this but ACAS came to mind when I read your post. Also, are you a member of a trade union by any chance? I guessing no because you would have contacted them for help if you were.
Contact ACAS they can help direct you and shed more light on your rights, where you stand and what to do. Perhaps take employer to the Employment Tribunal?

I find that employers tend to respond & take things a bit serious when they get a letter from ACAS or employment tribunal

I agree it would be very galling to not even be told the basics of your policy so that you can work with their decision. But I don’t understand why you don’t go straight to the ombudsman with it. For any sort of insurance policy it’s more usual to use the ombudsman rather than look at sueing. The ombudsman will ask for full details to be provided. I would expect you would get to see what the insurer provides on their side as part of it.

What job description were you given when you took the job? If I were you and I still have the job description given when the job started, I would send a copy to the employer asking them why it is different from the one sent.

I don't understand why OP keeps quoting own posts....

But he's my penny's worth. I believe 2 years down the line, OP has missed some major deadlines in regards to appealing decisions. Only way would be going down acas or ombudsman if there is a case of gross something rather, misleading or ill practice. Onbusman is a difficult and long process- plus, they seem to go for compromise if not very clear cut. Been there, done that in a different sector.

The employer has done their due diligence by giving OP the form to fill out - from experience these come with guidance and some small print.

Their decision of symptom rather than illness seems a bit patchy, but I assume that they expect employer & employees working together for a return to work within a responsible time. Reasonable can mean within 6 months while SSP is paid, so no or minimal payout from insurance.

I would also question if OP is still employed. 2 years being off sick with stress and then long covid is a long time. Was there never an attempt made of returning to work in all this time? 18 months without pay can also result in the insurance premium not being paid.
A whole new can of wormes.

OP, what are your future plans? Are you hoping for a back payment for the last 2 years for stress and then a payout for the next 2 years for long covid?

Do you want to return to work with this company or would you rather seek employment elsewhere or go down the PIP route?
Whatever your plans, focus on the future not the past.

This is the same for GIP at my work - they don’t pay for work related illness, so wouldn’t pay out for work related stress.

I agree, the ombudsman before sueing. I need help with the ombudsman as I don't know how to fight a hidden report, a missing list of illnesses or symptoms, etc. I believe I do have to be employed to get GIP, so if the employer gets rid of me, that will be it. I know the policy says that they would pay if in the event of accident or illness I am not able to do my job full time. I guarantee you I cannot do my job full time and I am not workshy. I have done really long hours and before I fell ill I worked from home the previous weekend and 12 hours straight on my last day of work. I didn't know I had covid when I was signed off with stress at work, but I had been bulied at work and couldn't take it much longer.
After a few weeks off sick, I realised I wasn't recovering as expected and started wondering what was wrong with me. Eventually I was referred to the long covid clinic and it wasn't until they diagnosed me that the fit note was changed to long covid. The fact that it was after 12 months is pure coincidence. For me to get paid or not, it doesn't make any difference at all. What matters to the insurance is the first 6 months of illness.

I wanted to discuss the issue with the GIP and how it had been dealt with by the employer. I didn't think it was right.
When I raised the other grievance, about something completely unrelated but I knew they were lying to me, they pretended to be having discussions internally about both issues. So, after a while, I thought I should raise it to at least discuss it, but they said it was nothing to do with them and refused to have the call at all.

I'm confused that you have a job if you have been off sick for more than 6 months, a year at most. You need to apply for sickness benefits, universal credit or employment and support allowance based on eligibility

But HR or your LM would tell you if your fit notes say so during the deferred period (6 months in my case). Wouldn't just let you go through the whole process and appeal for nothing. Right?

I am the beneficiary, and all we are told and given when joining, in the benefits package, is that after 6 months sick we get up to 2 years from insurance. We don't see the small print or even the policy itself.

Wasn't my employer failing their duty of care of something here?

But what is it that makes you think your employer should have been involved in your insurance claim? I mean, I know that they pay for the policy as an employee benefit, but it wouldn't be usual for them to get involved in any claims, so I'm not sure what exactly you were expecting from them?

It seems to me quite reasonable for them to decide that they don't want to invest staff time in a grievance process about something that falls outside the scope of their responsibility.

Could you explain a bit more about what specific responsibility you feel your employer had that they haven't fulfilled properly?

I should also add that sickness policies and income protection cover have eligibility criteria. Many do not cover conditions without a specialist diagnosis (so not just gp) or have a list of covered conditions. Stress is so vague that nearly everyone can claim it, it's also only a symptom consequently they would need a diagnosis of the underlying cause, if that is workplace they may not cover it

Op call ACAS now without further delay. They will give you advice and even tell how to reach out to the ombudsman

CALL THEM NOW AND STOP WAITING TIME & stop further delays.

ACAS -+44 300 123 1100

As I mentioned before, noone is covering for me. I work for a global consultancy that places their employees at clients offices for specific projects. I also wfh when in between clients or projects. I do not have an office to go to, or a team to talk to, unless I am placed with a client.

Also, what is the point of offering up to 2.5 years of 70% salary if kicking them out after 6 months?
Shouldn't they have given me an SSP1 or at least have a conversation with me about going forward after 6 months of enhanced SSP?
They ignored the fact that my fit notes would not get me income protection from the insurance, refused to put in writing the reasons why it was declined and didn't talk to me about it, after I asked them to please put it in writing before the call, so I could read it as many times as necessary and prepare questions about it. And 3 months later they contacted me like nothing had ever happened, and still not talking about the insurance at all. So I appealed directly again.
Isn't that duty of care failure? or negligence? or someting wrong in their part?
It feals like they couldn't care less about their employees, sickness, income during sickness, etc.

ok. what exactly do I ask them? I can't just tell them the whole story.

The employer has no authority over the decisions made by the insurance company. ACAS and an ET won't magically change that

What exactly should I ask ACAS please?
I don't think I could take employer to tribunal about not helping with insurance, after they provided the forms???

I provided a letter from OH within the long covid clinic. They ignored it saying it was based on my self-reporting.

I didn't miss any deadlines for the insurance. I spoke to them directly. It is a maximum of 2 years insurance cover, and only whilst still employed, regardless of how many years you are sick. I have heard of people still sick since 2020 with long covid; it's not uncommon, just not covered by the media so most people don't know. There are 5 million people in the UK alone with long covid. it is no joke.

OP your employer is not at fault here. They are under no obligation to assist you with the GIP claim.

Your claim was declined because the fit note stated you had "stress". Stress is not considered a medical condition for insurance purposes, it is considered to be a physical response to a situation rather than a medical condition in itself. It's very unfortunate that your fit note didn't say "depression" rather than stress, as this would likely have been successful. If you Google group income protection and stress you will see that this is a common issue.

There is nothing your employer can do to assist with a declined insurance claim. Do you want to go back to work? If you do you should return as soon as possible. I'm surprised they have kept your job open for you for this long and doubt they will continue to do that for much longer. Maybe consider returning and then looking for a new job while you are still employed.

Also, what is the point of offering up to 2.5 years of 70% salary if kicking them out after 6 months?
Shouldn't they have given me an SSP1 or at least have a conversation with me about going forward after 6 months of enhanced SSP?
They should have contacted you about sick pay stopping

They ignored the fact that my fit notes would not get me income protection from the insurance, refused to put in writing the reasons why it was declined and didn't talk to me about it, after I asked them to please put it in writing before the call, so I could read it as many times as necessary and prepare questions about it.
They wouldn't necessarily have known any of those details. When a claim is made the Company complete a form to support the claim (as does the person claiming) but that is as far as it goes. The insurance company don't go into any more details of why things were declined than they did with you, and the company wouldn't have been able to answer any questions

And 3 months later they contacted me like nothing had ever happened, and still not talking about the insurance at all.
The insurance was declined, there is nothing really for them to talk about with you

So I appealed directly again.
Isn't that duty of care failure? or negligence? or someting wrong in their part?
Nope, afraid not. Companies can provide benefits but claims are always subject to the insurances terms and conditions. I'm sorry your claim was not successful but there isn't really anything the company can do to help here other than signpost you to the ombudsman.

They are the policy holders. They have my fit notes. Shouldn't they know better? Are you expecting me to know about this better than them without even the policy?