Financial consequences of CBT/GET promotion/policy

[Orla]

This is the sort of insanity that happens when CBT/GET gets inshrined as official policy. Nuance or rationality goes out the window, and everyone is hit over the head with the CBT/GET mantra. Many CBT/GET promoters also work closely with the insurance industry which makes the situation even worse.

In the UK the insurer UNUM also works closely with the government and influences the government (social welfare) benefit policies.

http://forums.moneysavingexpert.com/showthread.html?p=31158885

23-03-2010, 1:03 PM #1
ellie43
MoneySaving Convert


I have read with interest the threads concerning critical illness.

If you are considering taking out CI cover you may wish to bear in mind
my experience. My policy is 'own occupation'.

I first became ill in 1999 when I did not fully recover from a bout of
flu. I was initially given a 'working diagnosis' of depression,
undertook graded exercise therapy (GET), cognitive behavioural therapy
(CBT) and was prescribed 6 different anti-depressants. As early as 2001
my GP notes indicate that ME/CFS was suspected. Also I reduced my hours
at work to 20 hours a week, but my symptoms of physical and cognitive
fatigue worsened. By April 2004 I was too unwell to work at all. In June
2004 I saw a NHS Clinical Champion with over 20 years experience who
diagnosed severe ME/CFS and stated that it was very unlikely that I
would be able to work again. In June 2005 I was awarded Ill Health
Retirement as a result of the disabling effects of ME/CFS.

In the Autumn of 2004 I made a claim under my critical illness policy
with Scottish Provident. This was the start of a nightmare lasting over
5 years. SP sent a psychiatrist to 'assess' me who diagnosed depression,
even though he said in his report I was not depressed when he 'assessed'
me. This psychiatrist has claimed training in the field of ME/CFS but
when repeatedly asked where this training was undertaken has refused to
respond. This psychiatrist recommended concurrent CBT/GET and further
antidepressant therapy.

By coincidence NICE recommend CBT/GET for people with ME/CFS, but not
for those severely affected by the illness. My claim was refused on the
grounds I had not had 'optimal treatment of CBT/GET', delivered by an
appropriately trained therapist. It should be borne in mind:

1) That there are no such ME/CFS therapists in my region East Anglia,
privately or on the NHS
2) Even if there were I am not well enough to travel to access and
participate in the therapy
2) My ME/CFS NHS medical team did not recommend further CBT/GET in my case.

Scottish Provident repeatedly refused to tell me what in their opinion
my diagnosis is and what medical evidence they would accept in support
of my claim. I asked them that in order to satisfy the policy would I
have to undertake further CBT/GET by a therapist specialising in
depression and also CBT/GET by a therapist specialising in ME/CFS.
Scottish Provident refused to clarify.

 

[Orla]

Continued

I made a DPA application to Scottish Provident who stated in their notes
that I was refusing to engage in therapy and so get better. What I had
actually said was that I would engage in therapies and treatment
recommended by my NHS medical team.

Getting nowhere I took my case to the Financial Ombudsman Service (FOS).
The FOS told me I had to provide 'compelling medical evidence of total
permanent disability', but refused to disclose what they meant by this.
Insurers, by dealing with the FOS over a number of years, know exactly
what is required.

In an email to Scottish Provident (obtained under the DPA) I discovered
that the FOS commented to Scottish Provident that it was clear I am very
ill indeed, that the insurer would probably have to pay out, so why not
pay out now?

After deliberating for over 2 years the FOS ruled in favour of my
insurer saying that although my consultant had stated 'I can state the
certainty that this patient will never work again' my insurer was
entitled to explore further treatments for depression. The FOS also said
that my ability to understand the issues and my persistence is evidence
of my ability to work. A real no-win situation, if I had not persisted
my claim would not be paid.

The FOS added that a way forward could be for me to obtain a further
report from a psychiatrist commenting on my mental health.

Link to source http://forums.moneysavingexpert.com/showthread.html?p=31158885

 

[Orla]

Continued

So I obtained a report from a psychiatrist specialising in the field of
ME/CFS. He confirmed the diagnosis of ME/CFS, agreed with my first
consultants opinion regarding prognosis and stated I am not depressed.

I sent this report to Scottish Provident in November 2008 who continued
to refuse my claim on the grounds that the psychiatrist had not included
'clinical objective evidence'. I asked Scottish Provident what they
meant by this but they refused to clarify.

By this time I had become very ill indeed. I decided I could no longer
cope and chose to employ a specialist solicitor. He recommended
obtaining further medical evidence from yet another ME/CFS Consultant.
This I did last summer.

At the beginning of this year Scottish Provident finally admitted my TPD
claim dropping their insistence on further 'therapies'. It would appear
that the involvement of a specialist solicitor and the weight of medical
evidence finally persuaded Scottish Provident that their position was
untenable.

Over the years I have spoken to a number of people claiming PHI and TPD
as a result of ME/CFS. Their experience has been uniformly poor. One
lady was told by Norwich Union not to bother obtaining medical evidence
as they would only take into consideration evidence provided by their
'experts'. I have documentary evidence (obtained under the DPA) that
Scottish Provident lied to me and misled me. My NHS medical team has
told Scottish Provident that their tactics have made my illness more severe.

I see from some of the previous posts that a high percentage of CI
claims are paid out. I suspect that this is the percentage of claims
that are pursued. There is a proportion of legitimate claimants who
simply give up because they are too poorly to cope with the tactics of
their insurer and/or do not have the savings to pay for private medical
reports and solicitors.

Link to source http://forums.moneysavingexpert.com/showthread.html?p=31158885

 

[Orla]

Continued

Note Peter White (who has been advising the CDC for the last few years. Also the CAA included a piece by him in a booklet for doctors).

It is interesting that the 'school' of psychiatrists who espouse CBT/GET
for ME/CFS have close links with the insurance industry. The Chief
Medical Officer for Scottish Provident who reviewed my claim for
Scottish Provident was Prof Peter White who also heads the ME/CFS clinic
at Barts. This clinic only 'treats' mild/moderate cases with - you've
guessed it - CBT/GET. Even NICE doesn't recommend CBT/GET for the
severely affected, yet that didn't stop PW advising my insurer that my
claim should be refused until I undertook CBT/GET again.

Also it is very easy to blame the patient if CBT/GET is not effective,
rather than looking more closely at the efficacy of the therapy. As my
consultant commented there is no longitudinal research evidence that
CBT/GET is remotely curative, or in the case of the severely affected
can bring about enough of an improvement for the patient to return to
work. The main problem with the research into the efficacy of CBT/GET is
the selection of patients. A very wide definition of 'chronic fatigue'
has been used, rather than for instance the Canadian Criteria for
ME/CFS. There is a huge difference between 'chronic fatigue' and ME/CFS.

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