Insurers under fire over treatment of ME sufferers

Last year FTAdviser.com revealed that an independent financial adviser had his permanent health insurance payments stopped by Norwich Union, because of the difficulty in diagnosing his condition of chronic fatigue syndrome. (See article.)

In the last 18 months, a dispute over the National Institute of Clinical Excellence (NICE) guidance on the condition has arisen, in part, because it emphasises that ME and chronic fatigue syndrome is a psychiatric condition rather than a physical one - something the wider ME community denies.

As a result, two adult ME sufferers Douglas Fraser and Kevin Short launched today's legal challenge, calling for a judicial review of NICE's guidelines for treatment of ME.

They want the guidelines altered to include more beneficial treatments, as symptoms of ME, which affects around 250,000 people in the UK, can include severe muscular and joint pain, extreme exhaustion, sleep disturbances and memory and concentration difficulties.

Jamie Beagent, an assistant solicitor at Leigh Day & Co, will argue that two members who sat on the panel that developed the guidelines were from the insurance industry and, as such, could have caused bias.

Beagent said: "There is a huge strength of feeling about the way insurance companies deal with these suffers. The main grievance is the way they handle claims. Often insurers send around medical experts who reach the conclusion that it is a psychological disorder."

The High Court matter is due to come to an end today (12 February), with a decision expected by early next week.

The Association of British Insurers (ABI) has said clear guidance on the illness from the medical profession would be a welcomed move.

An ABI spokeswoman said: "When insurers assess claims they have to be guided by the medical profession.

However, on this issue the medical profession is divided about both the causes and prognosis of ME, therefore clarification of the medical guidelines would be helpful."

Medical adviser to the ME Association Charles Shepherd agreed that he regularly encounters permanent health insurance disputes involving ME and chronic fatigue sufferers.

"It’s a long standing problem from the insurance industry’s point of view, they find it a very difficult disease to deal with and they are suspicious of such claims and are reluctant to pay out."

According to Shepherd, the fact that the disease cannot be diagnosed by a simple blood test makes the situation more difficult.

"The NICE guidelines recognises its disabling affects but indicates that it’s a psychiatric disease or mental disorder and this suits the insurers."