problem with income protection plan

mille100piedi

I have been receiving an income protection since 2012, this year my geneticist found out a mutation in a muscle gene so it is very unlikely I will ever get better and be able to go back to work. I went for a medical review and now after one month the payment has stopped. I still don't know what is going on, but in the case the insurance company doesn't want to pay I am not sure what I should do. My employer knows that I am not fit to work because he could see how my health deteriorated during the last years in the office. If the insurance company tell me that I am fit to work if I go back to work I will be sick over and over again and my employer will have to pay taxi to send me home every time. My illness is invisible but when I got sick it is very visible because I start to throw up, not be able to move much and my employer told me that I look like I am going to pass out. It doesn't take so much to get sick and this is the reason why I spend most of my time at home avoiding physical activities. The problem is that my doctor is in USA and here in Ireland I don't have a doctor that can support my case because the gene mutation is so rare and not well known. My GP supported me over the years but he doesn't know anything about this gene. So I don't have a definitive diagnosis, but what's happen if I go back to work and the same day my employer has to send me back home which is very likely? I am receiving invalidity pension as well and I will lose this if I go back to work, but since I will be sick already the first day, will I receive illness benefits again? Can the insurance stop the payment if I am not physically able to be at work? Sorry for the length of my question but I am very upset at the moment and I have suicidal thoughts.

Henry Ford III

Couple of thoughts.

1/. Claim discontinuance can't just be stopped without communication. I assume the insurer wrote to you, and gave reasons why.

2/. Your employer isn't a doctor. It's up to you to call in sick and get medical evidence and opinion to back that up. Illness isn't geo locked, so a local doctor (or specialist) should be able to assist.

3/. You are either medically fit to return to work or you're not. Without a definitive diagnosis however I think it'd be impossible to prove inability to work.

4/. Ask your employer about "linked claims". Basically the deferred period for PHI claims (minimum of 13 weeks) is bypassed in a series of claims caused by the same illness.

Time for some positive action, and it's in your court.

Sorry you are feeling low O.P.

skippy2

If you're GP says you are unfit to work then that is that. An employer cannot accept you back to work until you're GP says you are medically fir to do so.
"If the insurance company tell me that I am fit to work"............they do not have the power or authority to tell you, you are fit to do anything. They are an insurance company and will protect their money first and foremost. You need to be proactive in this

"My GP supported me over the years but he doesn't know anything about this gene. So I don't have a definitive diagnosis".........if you have a diagnosis by an expert in the US you have a diagnosis..........just because no one in Ireland knows about it doesn't mean it does not exist. But if it is recognised there then there is some consultant in Ireland who will be able to assist in some way

You're GP should also refer you to a specialist consultant here, they are as the name suggests a General Practitioner (GP) and so do not know everything. A specialist will be able to liaise with your US Specialist if need be to confirm diagnosis.
If you're illness is genuine the Irish Doctor who reviewed you on behalf of the insurance company I presume also does not have expertise in this illness so you can question their relevance in reaching any conclusion they are not qualified to reach.
If you have a Geneticist report which I presume you do and this shows the relevant data and tests I don't see how a doctor here who has no knowledge of the disease can dispute it. Ask you're insurance company for their reasons for refusing the claim or changing their mind do they think there has been a miracle. Question the competency of their doctor in reaching a conclusion he is not qualified to reach.
If they have been paying since 2012 did they not accept the claim then
They have a complaints procedure you should initiate this immediately and question everything they have done, they just want to make you go away

Is you're Income protection Policy linked to your employment or a Private Policy you took out

Who is you're insurance company or is it a case of most here can work out who the "Irish" insurance company are

Best of Luck

mille100piedi

Thank you for your replies
I did not received any letter from the Insurer. I was thinking that it is all a mistake, but my flatmates told me a letter arrived from the health insurance informing me that my policy has been cancelled. My policy belongs to a group scheme so it is very unlikely my policy would be cancelled by mistake. My employer probably sent the request to the health insurance to cancel my policy. I don't understand, I always kept a good communication with my employer. Does all this mean that I am fired? I am so worried.

I was referred by my GP to a neurologist at the Beaumont hospital but her assistant visited me, he wrote a letter telling that I am not fit to work, unfortunately the specialist came only for two minutes and now a physiotherapist is helping me to manage my condition.

I wanted a letter from a well known specialist and I booked him privately but he refused to see me because he said he doesn't know my condition.
Nobody want anything to do with patient with rare disorders.

I am glad I did the whole exome sequencing last year and I was very lucky that geneticists where able to find a mutation. I think doctors in USA are excellent! The lab and my geneticist sent me documents regarding the result and I send them to the insurance company. As skippy2 said I don't think the insurance's doctor has the expertise to understand the condition, but there are databases, where, after inserting the name of a gene, will give the probability of the gene causing diseases. Mutations in my gene give the probability of causing disease of 98%. So it is not a 100% diagnosis but it is very close.

Geneticist can give an opinion about the genetic matter but probably the insurer wants to know how this condition is affecting my everyday life and at this point I don't have a neurologist that understand my condition. They just don't want to deal with me.

They paid me since 2012, I don't understand why now, that I have a more definitive diagnosis thanks to genetic testing, they would stop the payment.

I remember the agent that came to my home when I said that there is nothing else I can do and I will have to learn how to live with this condition he made a strange expression with his face, I think he wanted to showed that he was very sad for my situation but I think he was very sad because he knew that I was going to cost a lot of money to the insurance.

The income protection policy is linked to my employer and the company is the "Irish" one

I am very upset, I hope it is just all a big mistake

notharrypotter

I have been receiving an income protection since 2012,

it is very unlikely my policy would be cancelled by mistake

Curious, you would assume that a policy in payment would continue unless there was a time limit to the payment.
Was the plan open-ended?

I have a more definitive diagnosis thanks to genetic testing, they would stop the payment.

Is this new diagnosis covered by the policy?

My policy belongs to a group scheme

Do you have policy documentation?

I did not received any letter from the Insurer

my flatmates told me a letter arrived from the health insurance informing me that my policy has been cancelled

Your flatmate opened your letter for you?

I always kept a good communication with my employer. Does all this mean that I am fired? I am so worried.

When did you actually last work?
Has someone else taken over your duties?
Has someone been hired temporarily to cover your role?
Was/is there an agreement to hold your position open for you?

I wanted a letter from a well known specialist

he refused to see me

he said he doesn't know my condition.

If the specialist is not aware of your condition then what is the point of having a meeting?

mille100piedi

I have been working for an health insurance company and to cancel an employee from the scheme the employer need to send a notification to the health insurance with the name of the employee and the date when the policy should be terminated. For this reason I said it is unlikely a mistake.
I am talking about income protection cover not critical illness insurance
Of course I have the policy documents, I pay the yearly premium. I even read the small print. As I said I worked several years for a big health insurance company.
yes my flatmate opened my letter, I don't see a problem here
I really hope someone else is taking over my duties, I can't imagine my clients still looking for me after so many years!ahahah!
Do you really know how income protection plans work?
How I was supposed to know when I sent a letter to the specialist that he wasn't confident enough to treat a patient with a rare condition like mine?
Some of your questions are really funny!

notharrypotter

Do you really know how income protection plans work

and

critical illness insurance

Direct relative knowledge of how both are supposed work.

I have been working for an health insurance company

I really hope someone else is taking over my duties, I can't imagine my clients still looking for me after so many years

My question was are you still an employee of the company?
If not then your former employer would have no interest in your ability to work.

The insurance provider on the other hand as you would appreciate would understand the subtle difference between no longer able to work in your former role as oppose to no longer able to work in general.

I went for a medical review and now after one month the payment has stopped.

and

yes my flatmate opened my letter,

Have you actually read the letter?
I would assume that this would be your immediate priority.

I went for a medical review

Your policy has a review clause?
If so it would be important to see what outcomes the review clause can result in.

mille100piedi

thank you for your help, but from you questions I can see you don't know how income protection plans work so it would be hard in your position give some useful advises. Skippy2 gave me good advises and I am already follow them

Henry Ford III

Is this an employers income protection plan OP? If it is the employer pays the premium.