This post details what Prof Peter White said at a previous speaking event at Swiss Re: in that event, White is basically explaining to these insurers how they can exploit the differences in the ICD disease classification of ME and CFS, in order to escape having to provide ME/CFS patients with disability support, which saves these insurers a lot of money, but leaves ME/CFS patients high and dry.
The unscrupulous trick used by these insurers is the
mental health exclusion: CFS — but not ME — can be considered a mental health condition according to the ICD classification of CFS, and I understand that disability insurance rules usually stipulate that they do not have to provide long term disability payments for mental health disorders. So unscrupulously and erroneously making ME/CFS look like a mental health condition is the get out trick used by insurers.
This is why the creation of the CFS disease category by the CDC in 1988 may well have been done in collusion with the disability insurance companies. In the 1980s, there was an apparent 5 to 8-fold increase in ME/CFS incidence (this data comes from several sources, including the disability insurer UNUM, who reported that claims for disability caused by ME/CFS had increased 500% from 1989 to 1993).
So the insurance companies at that time were desperate to figure out an underhand way to avoid having to make disability payouts to all these new ME/CFS patients. The creation of the new disease category of CFS appeared to be the answer to their prayers, but a disaster for ME/CFS patients.
More info on this here:
Fivefold to eightfold increase in the incidence of ME from 1980 to 1989, and also in
this post.
I am currently in the process of a critical illness claim and have posted in other threads. Have been doing research on it as I have always been told I cannot claim when I have rung up before. This time I asked them to send me details of why I was being refused, how they classify ME and how they classify "functional nervous disorder" which I have an exclusion for in my policy due to having depression when I took it out. A couple of weeks later they came back to me and said they actually needed more information and could I fill out a claim form. In the meantime I had been looking into it all in preparation for my complaint.
I found the following wording is currently being included in critical illness policies being drawn up this year:
In addition my consultant told me that he has been involved in a number of cases for patients and when going to court he had been chatting to the insurers, They told him that they will keep declining claims as most people don't challenge them. Even if they get taken to court 50% of people won't turn up so the insurers win. If the claimant does turn up then they actually go outside and settle with them on the steps. They are just playing the system as only a small percentage of people actually go through with the whole thing (probably because they are too sick and brain fogged) so they win the majority of the time.
I spoke to the person handling my claim last week and asked some general questions again about how they classify things. After much ducking and diving he eventually said that they don't have an internal written definition of ME but they do have it as an illness "of unknown cause". Functional nervous would mean "of unknown cause / medically unexplained" whereas functional neurological would have a biological explanation.
In the relevant insurers booklet on "understanding underwriting" which is for financial advisor use only and not approved for use with customers, they actually then classify mental disorders under two headings:
- Organic - These disorders are caused by, or associated with, disease of the brain tissue. An example of an organic disorder is a tumour.
- Functional - There is no clear physical cause for these disorders. They can result from an individual's inability to adapt to his/her environment.
In their sections on tumours there is no mention of any mental disorders and they class a tumour as an abnormal mass of tissue which grows at a different rate from the surrounding normal tissue.
Obviously they are trying to cover off all possible options for declining claims - but I find it astonishing the inconsistency of what they use internally with what the medical profession uses in terms of what diseases are classified as.
If every WW organisation classifies ME as a neurological condition (before anyone says NICE class it as a mental health issue they don't actually say that - they say that
"WHO classes is as neurological and some members of the Guideline Development Group (GDG) felt that, until research further identifies its aetiology and pathogenesis, the guideline should recognise this classification. Others felt that to do so did not reflect the nature of the illness, and risked restricting research into the causes, mechanisms and future treatments for CFS/ME." So they actually sidestep the issue and don't make a definite statement as far as I can see but they definitely don't say that it is a mental disorder but they imply it with their treatment options by calling them treatment rather than symptom relief.)
then how can insurers get away with putting ME in the "mental health disorder" categorisation that they put in their current policies. Surely this must be against some laws? I tried to get information from the insurance governing bodies about what insurance companies must do but they wouldn't provide it to a member of the public.
I am fully expecting to have my claim turned down but I will carry on through the process. I would love to think that it might be possible to expose the current classification that the insurers use and do something about it but I have no idea how to take this any further. If anyone has any ideas do let me know.