Income protection policies and ME/CFS: Important legal judgement involving Friends Provident (UK)

[charles shepherd]

Income protection policies and ME/CFS: Important legal judgement involving Friends Provident (UK)

A high-flying financier accused of being a “downright liar” and “faking” symptoms of chronic fatigue syndrome has been vindicated by a judge.

Charles Miley, 51, was condemned as a lead-swinger by insurance giants Friends Life who put private detectives on his tail.

They filmed him out shopping, down the pub with his mates and even at his daughter’s nativity play in a bid to prove him a liar.

Continued here:
http://www.coventrytelegraph.net/news/local-news/banker-set-millions-compensation-after-13717521

This is clearly an important and useful legal judgement for anyone with ME/CFS here in the UK who is (or has been) in dispute with an insurance company in relation to an income protection policy

The MEA has an information leaflet covering this type of policy (also known as permanent health insurance) in relation to ME/CFS:

http://www.meassociation.org.uk/shop/management-leaflets/income-rotection-insurance/

Dr Charles Shepherd
Hon Medical Adviser, MEA

 

[charles shepherd]

Also being reported in The Sun:

https://www.thesun.co.uk/news/4614886/banker-insurance-payout/

CS

 

[Large Donner]

Shock horror, a disabled person went to the pub and does shopping!!

 

[TiredSam]

Mr Miley, who said he had “nothing to hide” had been encouraged by doctors to be as active as possible

So the sufferer has to comply with the doctor so as not to jeopardize insurance payments. The doctor says be active. The sufferer complies by being active. The insurance company films the sufferer being active and says "see, he's not ill, we don't have to pay!"

Nice scam.

 

[TiredSam]

It would be interesting to know whether this case sets any kind of precedent, for example did the insurance policy have an exclusion for mental health conditions and was this held by the High Court (so binding on all lower courts) not to apply to Chronic Fatigue Syndrome? There could be a few aspects of this case that might set a useful precedent (or, dare I say it, open the floodgates) if we had some more details.

 

[charles shepherd]

Court judgement here: http://www.bailii.org/ew/cases/EWHC/QB/2017/2415.html

 

[TiredSam]

point 18:

No one has ventured any alternative genuine organic or psychological explanation for the claimant's symptoms

Looks like they missed a trick there. Or were advised that Wesselybabble, whilst sufficient in some quarters, may not stand up in the High Court.

 

[TiredSam]

Court judgement here: http://www.bailii.org/ew/cases/EWHC/QB/2017/2415.html

Excellent judgement, well worth a read, and not too much legal babble so interesting for a lay reader too.

 

[Esther12]

Slimy Anthony Cleare is involved too! On the side of the insurers. Would his submissions to the court be available for request? It might be helpful to know what people like this are submitting for these sorts of cases.

Here are the bits of the ruling which mention him:

Professor Cleare took a more sceptical approach suggesting that the court could conclude from the evidence as a whole that the difference between the reported levels of symptoms and impairment and the other evidence in the case casts significant doubt upon the diagnosis of CFS. He conceded, however, that, looking at the documentation comprising the contemporaneous medical presentation of the claimant, he would not have had a particular difficulty in diagnosing CFS, despite some atypical features. He went on to accept that in the early stages there probably was a level of CFS but questioned the persistence and severity of the condition. He went on realistically to defer to the judgment of the court on the extent of any unreliability thereafter to be inferred from the other evidence such as the surveillance footage. However, he was reluctant to conclude that on any reading of the evidence the level of the claimant's symptoms was other than mild.

Thus the issue as to whether the claimant is lying is inextricably bound up with the issue as to which expert evidence to prefer. It may well be for this reason that there were occasions when Professor Findley and Professor Cleare each gave the appearance of placing greater emphasis on the primary evidence which would seem to be more consistent with their respective medical conclusions. The defence experts, for example, naturally focussed on such activities as skiing and cycling whilst, in the case of Professor Cleare, appearing to be somewhat uncomfortable about the video evidence showing little or no activity in any given day.

In summary, I found the evidence of Professor Findley on the whole to be more persuasive than that of Professor Cleare. I found the latter to be particularly hesitant about making sufficiently prompt concessions where he may have thought that they may have lent some credence to the claimant's case. In particular he appeared to be unnecessarily reluctant in reaching the conclusion, which he eventually did, that the claimant probably was suffering from some level of CFS in the early stages of his presentation. I also formed the view that Professor Findley's approach more closely reflected the uncontroversial understanding of CFS as an elusive and fluctuating condition.