Permanent Health Insurance or Long Term Disability Payments Claims

If you have had to make a claim against a permanent health insurance policy, we understand the utter despair you probably feel if your claim has been rejected. Insurers often promise the earth when they think you will not claim against the policy but sadly, they will then use every technicality under the sun to prevent a payout when you desperately need it.

It is not unusual for employers to offer long term disability payments as an employment benefit. These are essentially payments (normally a percentage of your salary) which you are entitled to if you are unable to work due to medical problems. These are not necessarily medical problems caused by your employment.

In almost all of these cases your employer’s payments are backed by a permanent health insurance (PHI) policy and your entitlement to payments under your employer’s scheme are linked with that PHI insurer’s liability to pay out.

It is common for employees to face considerable resistance when they attempt to make claims against these policies and for the employer and/or insurer to dispute any entitlement. Among the common grounds for dispute are:

  1. Challenges as to whether the employee has any medical condition.
  2. Arguments by insurers that the medical condition suffered by the policy holder is insufficient to require them to cease working.
  3. That the employee does not meet the criteria to receive payment.
  4. That the employee’s claim is discretionary because their employment has been terminated.
  5. That the employee is not one of the staff qualified to receive the benefit.

We help many of our clients, particularly when they suffer serious injuries, to bring claims on behalf of employees who have been denied cover under PHI for damages for breach of contract and seeking to compel the insurer to make payment. All cases are conducted on a “No Win- No Fee” basis so you really do have nothing to lose.

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