Income Protection & CPAD Assessment

 

"Can a machine be a fair judge? 

Concern is growing over a computerised test used by

 insurers to decide whether ME claimants are genuine"

 

Art behind the MEAI blurb by unknown

Salary Protection with Private Insurance Companies & the Chronic Pain Abilities Determination (CPAD) Assessment

Everyone gets sick from time to time, but a long term illness or accident could stop you working permanently. Some people have paid into an income protection scheme in the event that they become ill long term though may people thankfully do not have to avail of the protection payments. Should chronic illness happen, your income protection policy would take over. That's the idea anyway but not always what we see in practice.

Income Protection is designed to provide an ongoing income of up to 75% of your normal salary (including any social welfare benefits) whenever you are unable to work due to any accident, illness or disability until retirement.

Income Protection is a unique form of insurance that's available for employees, company owners, and the self-employed. It is also tax efficient.

Income Protection providers in Ireland, which are usually insurance companies include Aviva, Irish Life, Zurich, New Ireland Insurance, and Royal London.

 Income Protection Payments

Our information about Income Protection Payments includes details and advice for anyone:

- claiming or appealing Income Protection Payments (also called Salary Protection)

- wishing to know more about Public Health Supports available that you may be interested in if you find yourself in financial difficulty as a result of ill health and cessation of work and income, or because of refusals of income protection payments. Public health supports mentioned include Supplementary Welfare Allowance, Illness Benefit, Invalidity Pension, Disability Allowance & there is also some information about Appeals processes.

Please see more here

CPAD Assessments

What is CPAD?

CPAD stands for Chronic Pain Abilities Determination (CPAD). The CPAD is a combined physical and cognitive assessment conducted across two days to determine the working capabilities of individuals. Most commonly used for cases where both cognitive and physical restrictions are reported, and functionality is reported to be impacted following a period of exertion, it is used by insurance companies & occupational health physicians for claim assessment purposes, or return to work planning.

The initial part of the assessment consists of a standard history taking, principally focusing on the patient's self-reported physical and cognitive abilities and disabilities, as well as the completion of established pain and fatigue scales, and relevant disability questionnaires.

Following this, physical and cognitive abilities are assessed on two separate days, utilizing computerized hand-held dynamometers, inclinometers, algometers, and force dynamometers. Specific work simulation tests using the industrial standards Methods-Time-Measurement testing are availed of. Computerised neuro-cognitive testing is also utilised as a component of the assessment.

 

As per an independent service provider to the insurance, corporate, occupational health physician and rehabilitation sectors ‘CPAD is designed to specifically and objectively measure the work capacity of an individual suffering from chronic debilitating conditions with respect to their normal occupation, utilising an extensive combination of valid and reliable testing, the results of which are free from both examiner and individual subjectivity.’

 

Form Health (UK) is a service provider to the insurance, corporate, occupational health physician and rehabilitation sectors. They are specialists in assisting individuals back to work and use the CPAD assessment. See more Information about CPAD on the Form Health website here.

 

What does CPAD mean for people with Myalgic Encephalomyelitis (ME)?

 

For a person with ME who can no longer work CPAD is a tool used as part of an assessment to determine financial security rather than to determine work capability and the outcome greatly impacts on their economic wellbeing.

CPAD is not a suitable assessment tool to diagnose, confirm or question the validity of Myalgic Encephalomyelitis; CPAD is not an objective measure of the work capacity of an individual with Myalgic Encephalomyelitis, as confirmed by feedback from the ME patient Community; CPAD Assessors have not been trained to understand the limitations of a person with ME to perform, neither do they know enough about ME to safely assess all cases without causing significant relapse.

 

Here’s more information on the two-day CPAD assessment which is usually carried out in a patient’s home on the two days, but can take place at another venue if the patient prefers. The assessment lasts about 2 hours. A quick glance at the article about CPAD shows again how unsuitable it is for people with ME.

 

 

 

Insurance company and work assessments appear to be designed to find everyone able for work, even the most ill and disabled. We heard of a very severely ill and disabled man who can only get around by being pushed in a wheelchair, attending with a Dr X in a reassessment with regards to salary protection payments, who denied the man’s disability and deemed him fit for work, denying him of future salary payments. The man had paid into the insurance for decades in the event that he ever became too ill or disabled to work.

“When I saw Dr X as part of my assessments under a well-known Irish insurance company they gave me two glances and deemed me fit for work… without a single test, without any relevant tests, and without asking me about Myalgic Encephalomyelitis (ME). I appealed and following that failed appeal I was made to jump through further hoops by the insurance company. By that I mean I was requested to do a CPAD assessment (2-day assessment in my home), and after failing that test and appealing the outcome I was sent to yet another doctor who had me fill a very long psych questionnaire, followed by a short interview, then a cognitive test on a laptop similar to the one during the CPAD assessment…. another 'failed' assessment.

I appealed again and lost again and didn't take it any further as I was too unwell and did not have enough energy to brush my teeth, whatever about being by own agent in a fight for financial support. Needless to say, I lost income. But my health was more important. I knew a lady at the time who took the Insurance Company to the High Court and won her case. That was years ago and since then I have heard that insurers make people who continue receiving payments do therapies which are totally unsuitable for people with ME, e. g. CBT/GET.”

 

 

 

Information & Advice re CPAD Assessment

With Myalgic Encephalomyelitis (ME) you may or may not have a choice...to do a CPAD assessment if your insurance company, or other, has required you to take part in one.

You may do the assessment to satisfy the obligations as per your insurance policy, difficult and all as that will be, or you may refuse to do it because you have to on ill health grounds. 

It may be worth looking at your policy to check the policy definition of incapacity to have a better idea re what you are up against.

Whatever you decide to do you need to look at the small print in your policy because if you do not comply with the Insurance Company's assessments then that may be the end of your claim. 

It is a catch 22 situation because no matter what you decide, it is likely that you will lose your payments, or at best continue to receive payments but be obliged to do regular assessments and/or suggested courses, e.g., Graded Exercise Therapy (GET), going by a large bank of feedback from people in the ME community.

 

If you are on work leave because you are too ill to be at work then the likelihood is that you are too unwell to do this physical and cognitive two-day assessment. Don't let the insurance broker bully you into doing the assessment if you are not up to it, but be warned that the insurance company, usually the broker, have a habit of saying that refusing the assessment means an automatic refusal to reinstate payments.

 

If you feel you have to attend the assessment for whatever reason then you could, ahead of any scheduled assessment, ask what knowledge the assessor has of ME, ICD G93.3, so that you can have confidence the assessment is a fair one based on knowledge of the effects of ME. The likelihood is that they have no knowledge of ME, or they wouldn't be putting people with ME through their inappropriate assessment.

 

The insurance companies have it all stitched up to suit themelves with policies designed to catch you out and an assessment masquerading as being an objective tool. If you are too unwell to do an assessment you are too unwell to go to work. That is the bottom line. Avoid the being available for an assessment. But if you don't make yourself available for assessment you may lose your payments and in the assessor’s eyes you turn up, therefore you are fit for work. If you cannot physically take the assessment you need to let the insurance company know you cannot attend the assessment because of your illness and provide a supporting letter from a consultant stating that you are too unwell to take part in the assessment, outlining the details why.

 

Feedback from people with Severe ME tells of a patient whose claim was immediately terminated (they lost their payments) when they stated they could not do the assessment on severe ill health grounds. There is something in what one signs up to that you cannot refuse what they see as reasonable requests. You need to check the small print of your policy very closely. There was also feedback from a lady with ME whose insurance company accepted her consultant's supportive letter stating she was not fit for an assessment, they cancelled the scheduled CPAD, but suggested therapies she had to do if she wanted to keep her payments.

 

Doing any therapies suggested by an insurance company, or other, is inappropriate because the likelihood is they are totally unsuitable for someone with ME, and it most certainly is not the insurance companies job to treat you. Some of the therapies reported to us have included CBT and GET, both of which are unsuitable for people with ME and have the potential to be harmful...basically anything that involves you having to be active either mentally or physically may be harmful. (see Workwell letter & other docs re GET futher down)

Moreover, being available for any suggested therapies means you are available for work in the insurance company’s eyes.

 

“I queried the relevance of the CPAD assessment prior to doing it and I was advised by the broker to do the test regardless of what the test actually assessed, or I’d lose my payments. Needless to say, I was assessed as being capable of work as are many with ME. Showing up for the assessment appears to mean you are capable of work. No matter how unwell and disabled you may look they will use something against you to prove you are fit for work.” - Patient Feedback

 

 

 

 

What to do

•        ahead of a scheduled CPAD assessment
•        if you are not happy with the outcome of the assessment, i.e., with the content of the report following assessment

 

1.              If you feel you cannot attend the assessment for whatever reason then you could ask what knowledge the assessor has of Myalgic Encephalomyelitis (ME) ICD G93.3 and state that you have full confidence that the assessment is not a fair one based on knowledge of the effects of stress and activity on ME. Asking the company for their policy at the start is a good opener.

 

 

2.              Get a strong letter of support from a consultant to evidence your debilitating symptoms and your inability to work as well as your inability to attend an assessment. Let your consultant know that you urgently need to see them for the purposes of getting a letter to prove you are unable to do a CPAD assessment. See more further down on how a consultant can help.

 

 

3.              Along with a letter from your consultant add completed questionnaires to evidence your inability to work as well as the inability to attend an assessment. The DSQ2 Symptom & Severity & PEM Questionnaires from De Paul University are based on research, are strong evidence of your illness and the impact of attending work and/or an assessment.

See links to the two De Paul questionnaires below: -

 

De Paul Symptom & Severity Questionnaire

De Paul PEM Questionnaire

Complete both questionnaires and submit those with your consultant letter, etc.

 

 

4.              Add this Health-Related Quality of Life for Patients with Myalgic Encephalomyelitis paper from Denmark here

 

 

5.              Workwell Foundation’s letter re inappropriateness of GET for healthcare providers who do not realise the harms caused by GET and CBT, i.e., those who try to push GET and CBT on you or a patient in your care. Send this also as it will support why you cannot do GET and at the same time show that any activity i.e., the CPAD test is unsuitable for someone with ME.

Workwell Letter

 

GRADED EXERCISE THERAPY(GET) WARNING handouts explaining the dangers of GET from ME International

here

Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: AHRQ ADDENDUM 2016 Conclusion here

See Page 13

 

 

6.              Add any recent test results/reports you have had that could further evidence the debilitating nature of your illness.

 

 

Anything that you send to your insurance company you could send by registered post so that you can then track the delivery online and see who signed for it and when.

 

All the above is enough to evidence (1) the physiological nature of your illness; (2) why any future assessments could be harmful and would cause deterioration - therefore your ‘refusal’ to do an assessment is based on the fact that you are too ill to attend and that if you did attend it will cause harm; and (3) why you are unfit to work.

 

 

More on the CPAD Assessment of Someone with Myalgic Encephalomyelitis (ME)

It appears that many people with ME (& various other conditions) in Ireland have been denied salary protection payments by insurance companies who use the CPAD assessment. Some patients have reported receiving payments for a few months but are soon reassessed, then denied continued payments; others receive payments but are obliged to commit to suggested therapies unsuitable for people with ME.

Many of those patients have reported that they have been assessed by an assessor from the UK who appears not to be qualified to assess ME.

The CPAD assessment is based on a set of tests designed to stop welfare cheats etc in the UK.

A true assessment of ME requires substantial biological testing as outlined in the International Consensus Criteria and Primer and depends on the severity of the person with ME.

There have been scientific & legal challenges to Functional Capacity Evaluation (FCE) in testing disability in ME. Here are links to some articles on the scientific and legal challenges to the functional capacity evaluation. These are very old but show Refutation of the use of Functional Capacity Evaluation (FCE) in testing disability in ME: -

Article 1 here

Article 2 here

Article 3 here 

Article 4 here 

 

 

What Service Providers Say About Their Use of CPAD

It appears that CPAD assessors have written a lot to defend their assessment tool and use of the tool. One service provider to the insurance, corporate, occupational health physician and rehabilitation sectors says ‘the Financial Ombudsman Service has recognised and found in favour of the CPAD conclusions in both the UK and Ireland, and CPAD has been successfully defended in the Irish High Court’, and they refer to ‘extensive literature search, peer reviews and researched components of current methods for assessing physical and cognitive abilities’….. but they do not in any way appear to recognise that the CPAD tool is entirely unsuitable and inappropriate to assess Myalgic Encephalomyelitis (ME).

 

Here is a PowerPoint presentation about the CPAD from one of the service providers, Form Health (UK) who use the tool. As said previously, Form Health (UK) is a service provider to the insurance, corporate, occupational health physician and rehabilitation sectors, they are specialists in assisting individuals back to work. 

The Problems with the CPAD Assessor's Report

Feedback from people with ME shows that assessor reports following CPAD have been exaggerated, non-objective, repetitive, and surprisingly non-factual, for example, some people with ME who did the CPAD assessment received a report which recognised some issues e.g., cognitive problems, but which falsely stated they exaggerated parts of the CPAD assessment.

The word ‘exaggerated’ has been used in some reports for example, the conclusion in some reports, as per patient feedback, stated that some test results had ‘inconsistencies and discrepancies’ and ‘the physical abilities demonstrated by X cannot represent her true abilities, and I can only conclude therefore that her actual abilities are far greater than she was willing to demonstrate over both days of CPAD testing.’

Reports given to people with ME tend to look the same.

The word "normal" in some reports is used and used quite a few times describing how the person being assessed approached some of the physical tasks, for example "normal reaching out".

The assessor’s use of language in a lot of reports creates a sense that all is fine and normal and that there are no apparent difficulties.

The assessor's reports appear to highlight an assessment that is not objective and quite twisted in favour of the insurer.

“I did have some breaks in testing, and I remember that the assessor watched me in the breaks. My report said that 'her abilities to wear clothes and sit against the back of an armchair (which was observed during the breaks) are not consistent with her reported tenderness.' They also declared some of my physical tests invalid as the readings were greater or less (depending on the test) than expected. The conclusion in the report stated that some of my test results had ‘inconsistencies and discrepancies’ and ‘the physical abilities demonstrated by Ms X cannot represent her true abilities, and I can only conclude therefore that her actual abilities are far greater than she was willing to demonstrate over both days of CPAD testing’.” - Patient Feedback

Other feedback mentions similar phrases in reports, particularly the line about ‘inconsistencies and discrepancies’. In other words, the assessor infers that people being assessed are lying. Anecdotal evidence shows that people were shocked by their reports.... they felt insulted and demeaned.

Be prepared for this. Do not trust the assessor, they are not there to make sure you will be looked after, they are working on behalf of an insurance company that want rid of you, they will twist what you say and use it against you. They use language slickly and focus on the things that you can do, some of which may seem irrelevant.

 

“They go on to say that there are no barriers to prevent me returning to work from a physical perspective. This testing in no way showed my physical limitations. My cognitive tests apparently did not contain ‘any evidence of symptom exaggeration’ and did show that ‘there may be cognitive barriers preventing’ a return to work. So, the testing showed up the cognitive issues but not the physical. I think that this was the same for others. The assessor’s final comment was that ‘it should however be noted that Ms X was able to converse normally at all times’ and ‘she asked very pertinent questions’......as if this somehow calls into question my claims of being ill and my inability to work. The test that is done is 'non-medical' according to my insurance company.” - Patient Feedback

 

 

People with Myalgic Encephalomyelitis are not just up against insurance companies, they are struggling with access to welfare, to ME-aware doctors and appropriate treatment and management, as well as having to battle chronic disabling illness and putting up with accusations of being malingerers and notions of their illness being all in the head. 

Progress in research and treatment has been hampered by a number of factors, including the outdated opinions of psychiatrists and some healthcare professionals, the people who should be supporting patients are the very ones going against them. 

Many patients who have undergone the CPAD assessment have described the assessment as stressful before, during and after; the assessment has exacerbated their symptoms; and some have reported a decline in their health.

Image by John Herd

Making an Appeal

You could use a supportive consultant to support you to dispute your report following CPAD assessment

It seems that the only way to dispute the CPAD report is to get a ‘bigger hitter’ i.e., a consultant who knows more about your illness than the evaluator does, to refute his claims.

Your consultant needs to get across that they are more knowledgeable and more qualified than the CPAD evaluator. Advice from an independent insurance broker to a person with ME suggested that this may be the way to go. 

 

The Consultant could-

-compare the tender point tests and question why a functional evaluator was doing a tender point test

 

-talk about “substantial conflicts” between the CPAD conclusions and their professional medical opinion

 

-state that the patient suffers from a recognised medical condition, and that based on their extensive clinical experience, the patient is genuine and has a very active disease with a full house of manifestations

 

-that a series of tests and procedures has excluded other organic diseases

 

-that in their medical opinion X is unfit for work now and in the foreseeable future

 

-that the CPAD evaluator is not in a therapeutic relationship with the patient

 

 

 

In the Holocaust vs Friends First court case the consultant’s opinions definitely had more value than the CPAD evaluator and Holohan was awarded his income protection payments, and back pay. The judge stated that “The court prefers the tender points testing of Dr xxx and Professor xxx to that of the CPAD test”.

 

 

If you were to go down this route you could also get an occupational therapist report. They can do medico-legal reports. You could also get a neuropsychologist’s report but it is hugely expensive at €1500+ but it could support the face that you have a lot of cognitive difficulties.

 

 

Successful Appeal following CPAD Assessment Outcome - Sample Appeal Letter

We have been sent a long and detailed appeal letter written by a person with ME who successfully had the CPAD assessment outcome overturned in their favour, i.e. the person wrote a very strong letter to the insurance company/broker to detail the irregularities and exaggerations, among other details, in the report following their CPAD assessment. If you wish to see this letter which we have anonymised please contact us by email at info@meadvocatesireland.com

 

Data Request (not FOI)

 

Please see information via link on putting in a data request if you want to see what information the Insurance company hold about you e.g. reports after any assessment:

 

How to access your personal data under the GDPR (citizensinformation.ie): https://www.citizensinformation.ie/en/government-in-ireland/data-protection/rights-under-general-data-protection-regulation/

 

Sample letter below when requesting information about you:

 

"I, XXX wish to make an access request under section 4 of the Data Protection Act 1988 and 2003 for a copy of any information that you keep about me on computer or in manual form in relation to my claim for Salary/income Protection. Claim number ...."

 

Perhaps a solicitor could do a data request on your behalf if you are unable to do it yourself.

 

I would suggest that you are specific in the data request letter e.g., stating the assessments you had and the names of the assessors so that they do not leave out any information on you re assessments you have already had.

 

It’s best to send your request by registered post so that you can track it and find out the name of who signed for it and what date and time it was delivered. If the insurer claim not to have received it you can provide them with the information you have via the registered post tracking when. 

 

 

 

More Personal Feedback About CPAD 

What the CPAD Assessment consists of – by a person with ME who completed the CPAD Assessment a few years ago (they include useful notes & advice)

 

"The CPAD appointment letters sent to me from the insurance broker said that I could have a family member or friend in attendance. It is best to do this and to ask them to answer the door, offer a cuppa, get you a drink, do anything that you need.

Here is what happened on the days of the assessment & what was said in my report following the assessment:

1) Clinical history, questions about symptoms, work history and demands of my work role, if there are any parts of my job that I can do, barriers preventing a return to work, aggravating or alleviating factors that affect work capacity, past treatments, and current treatments and how effective they are and if there are any side effects. Also questions about my average day and what I can and can't do...I was asked about hoovering, cleaning windows, cooking, opening tight jars, using cutlery, loading/unloading a washing machine, washing up at the sink, sweeping/mopping, gardening, DIY, ironing, making/changing beds, using a PC/laptop, using the toilet, shopping, showering/bathing unaided, self-grooming, getting dressed/undressed unaided, driving, travelling as a passenger, using a telephone/mobile, child care, and hobbies.

 

                                                                                                                                                   

NOTES for (1) The assessor, an assessor from the UK, watched everything I did, not just the test. In the report they commented about me sitting in a chair "without apparent difficulty", that I "conversed normally at all times", "walked around the house with a normal cadence", opened a door "without apparent difficulties", and that I showed "normal cervical flexion" whilst completing the questionnaires. They used the word "normal" in the report quite a few more times describing how I approached some of the physical tasks, for example "normal reaching out" for a questionnaire and for the testing.

The assessor also wrote in my report that I performed some tasks better "on distraction" than otherwise. Not sure what that means.

The assessor’s use of language in my report created a sense that all is fine and normal and that there are no apparent difficulties.

 

I know that other people with ME pushed themselves to sit at the table for too long because they looked on it as an official thing that they had to complete. It is, and they may very well reject your claim outright if you don’t agree to do the CPAD, but they rely on this and use it against people. In reality people are so uncomfortable and in pain and would be better off saying so and to ask for a break or discontinue the assessment if needed. If you need to be lying down or need to lie down in the middle of it then lie down. If you have a reclining chair or sun lounger that you normally use you could have that there and say that you can’t sit upright any longer.                                                                       

People make a big effort to look presentable and try hard to do it all whilst feeling awful which is not wise as then the assessor can’t see your true lack of functional ability.

Think of it as your worst day as that is exactly what prevents you working and don't make too much of an effort to be presentable.

People with ME have lots of trouble remembering things so have all your notes in a folder and refer to them, e.g., basic medical history with dates, treatments tried, symptoms, typical day, a list of chores around the house and ability to do or not do them, a list of the duties of your job and how symptoms affected these duties. Have anything there that you think that you may need e.g., dates last worked.

When you talk about your symptoms or activities don't minimise it as people with ME often do. Tell the assessor what it's like for you e.g., everything is a struggle, and everything causes more pain and fatigue. Describe your worst day, not your best. Also, if there is a task you can do, stress that you may not be able to do it some days but when you can you can't do it for a sustained period of time or repeatedly or reliably or efficiently or in a reasonable time frame. If you say you can do it, then they will think that you can always do it or can do it all day unless you say otherwise. Also, when answering questions about your abilities it’s better to answer for what it’s like on your worst day.

 

 

 

 

 

 2) Questionnaires and rating scales, e.g. Impact Questionnaire, Chalder Fatigue Scale and a VAS- Visual Analogue scale, all repeated on the 2nd day of testing. 

 

NOTES for (2) Remember to describe your worst day.

 

 

 

3) Physical Tests.

During this set of tests, I was asked to rate my energy level and pain level before and after each activity. The pain scale is from 0-10 with 10 being so much pain that you have to go to hospital. A patient was told that the scale was 0-10 but that 7 was going to the hospital but this was not explained in the report, so it looked like her pain never went over 6.5. If the assessor says this maybe ask for clarification and ask if 7 is going to hospital then what is 10? The Fatigue Scale is from 10-20. The assessor will also tell you to stop if you feel pain. There are a lot of activities, so you have to rate a lot of times.

 

The physical tests come in three parts.

The first is Methods Time Measurement Analysis which tests handling and fine finger dexterity of both hands, reaching out, reaching up, Walking, Carrying and lifting. The assessor had me walking about 2 metres from the table to the kitchen and back again. The assessor asked me to lift up their big case which I tried, …that probably went into the assessor’s report also.

 

The second part is Functional Activity Measurements which are done by gripping and pinching a dynamometer/metal part of a machine that is connected to the assessor’s laptop and apparently measures your effort, as well as ability. The tests are Hand Grip five position, rapid exchange grip and pinch testing. The third test is Range of Movement testing which tested my range of spinal movements. The assessor asked me to bend forward and backward from the waist.

 

 

 

NOTES for 4) If any of the physical tests are painful or tiring, tell the assessor. If any are beyond your capability or will do damage, tell the assessor that too. Don't tough it out or try extra hard because it will not show your true inabilities and will leave you worse off afterwards. In the information about the CPAD it says that they also do aerobic testing which is the 6-minute walk test and/or the CAFT/ Canadian Aerobic Fitness Test. You can refuse to do tests if you are not able for them and feel that you will suffer from payback as a result of having ME.

 

 

5) Cognitive Tests.

 

These are all done on a laptop, the time taken to complete and the number of correct/incorrect answers are recorded. They involve symbols, numbers, and letters.

 

The tests are-

 

Visual Memory testing: immediate and delayed memory recall.

 

Stroop test: reaction time and information processing.

 

Symbol Digit Coding test: visual perception and complex attention ability.

 

Shifting Attention Test: ability to shift from one instruction to another.

 

Continuous Performance test: sustained attention and reaction time.

 

Overall, they took less than 30 mins (a long time to try to concentrate with ME!)

 

 

 

NOTES for 5) These mental activities are difficult and very tiring for people with ME. Refuse to do saying you are unable/ask for a break in the middle. One of the tests has flashing images (Symbol Digit Coding) which really hurts the eyes.

 

That was the testing. It may not be exactly the same for you or may not be in exactly the same order. The assessor may have flexibility in which tests they use for different people."

 

 

 

 

 

Patient Feedback re CPAD

 

“I had permanent health insurance as part of my job. Assessment every 6 months. Got about half my salary on it. Had it for 3 years. Then insurance Co doctor said I would not get better, and my company terminated my contract so payments ended as well as job.” 

 

“I am in the midst of a drawn-out income protection claim process that began in April. Despite an extensive two-hour interview with a nurse, an independent medical with a doctor and a report from my consultant, confirming unfit for work due to ME, post exertional malaise (PEM) and array of fluctuating symptoms, I have now been informed that I must undergo a Chronic Pain Abilities Determination (CPAD). It will be a series of physical and cognitive tests taking 5-6 hours over the course of two days to help determine the safe abilities to perform work related activities. Although I do have muscle and joint pain, it's the LACK OF ENERGY and PEM that are restricting my return to work. I feel these tests are neither appropriate or safe and would not produce results reflective of the condition. I'm hoping my consultant will write a supporting letter to indicate this. But I'm also conscious that this could jeopardize my claim being approved. I know that others in similar circumstances echo my concerns”.

 

“I have heard of someone who recently (within last 6 months) had to retire as she just couldn't keep going and whatever insurance she had was refused as the illness was not recognised. I think this happened to many people. I wondered if she had been able to wait until NICE guidelines would it have made any difference. It is such disgrace; she had been paying in for nearly 20 years. Another serious harm done. I think this was to pay out %of salary until retirement age.”

 

“I got my reports re the CPAD back from XX via the GP and apart from being dotted with inaccuracies it states that I manipulated the test in several places, in so many words. I remember having to put pegs in pegboards - quite a stupid task- and apparently I purposely manipulated that task! Not sure how that was measured!! Crackers!!”

 

“The assessor did a Fibromyalgia tender point test as part of the CPAD I went through, and when I asked the assessor how they could do that as they are not a rheumatologist, they couldn't really give me an answer, but did write in my report that even though I had cognitive issues I was able to ask "pertinent questions"!! Way to turn my criticism of the CPAD around and use it to their advantage!! My Insurance Company assured me that the CPAD is a "non-medical" test, so I don't know how they are allowed to carry out a test that is normally only done by rheumatologists.”

 

“My report following the assessment was basically the same as everyone else that I have spoken to about it.

Mine was...

- Physical capabilities- "inconsistencies and discrepancies" and a conclusion that my "capabilities are far greater than she was willing to demonstrate"

- Cognitive capabilities-"suggest that there may be cognitive barriers from preventing Ms X from a return to her normal role on any basis".

This cognitive part seems to have been then ignored by the insurance company and it was only the occupational health doctor who said I was unfit at this time that allowed my claim to be paid.”

 

“My friend did badly in some tests which the report highlights as very unusual but then because she was able to follow the instructions or answer questions that contradicted it - so they concluded that she was over exaggerating. It seems to me that if you do well in the tests they maintain you are fine. If you do badly then it means you are exaggerating. I don't think it considers that you might be stressed or flustered or tired or have varying conditions. Expect to be tired after it.”

 

“If one succeeds at these stages one is regularly assessed and possibly therapies are suggested. One lady I remember helping was told she had to do a course of CBT to fulfil their requirements for continued payments. The therapist then reports back to the insurance company to say how that's going and can possibly suggest that the claimant is fit for work. I've heard of various types of outcomes over the years from people. If one is willing and able to keep going through the various stages it is possible to win back payments. The thing is they don't ever leave one alone. It's a good long fight.”

 

“I'm not sure that having a friend / husband/partner etc present changed the outcome of a CPAD assessment unlike at an oral hearing for Social Welfare, but I'd certainly suggest a friend etc for the CPAD two-day assessment so that the claimant is doing nothing at all physical i.e., answering the door, making tea etc. In fact, if at all possible have the assessment in your own home so that you are not travelling and seen to be able to travel, unless of course it's very obvious that you are immobile and using a mobility scooter or wheelchair.”

 

“As I understand it, if you do not comply with the insurance company's assessments then that is the end of your claim. My poor foggy brain is having trouble remembering but I think that this is in the conditions of most policies that you sign up to.”

 

“I questioned the assessor as to how they factor in PEM (post exertional malaise- how ill physical or mental activity makes us) and they said that that's why there is a rest day in between. I was very bad on the 2nd day of testing but that was not apparent in the test results.”

 

“An important point to remember is that alongside the CPAD many people have had surveillance from private investigators and been filmed going about their day. One person was filmed entering and leaving her house and entering and leaving her mother’s house and she was accused by the insurance company of being too active. Some feedback from patients alleges that they have been questioned about Facebook photos where they are out and smiling!!”

 

“My Facebook and my ex-partner's Facebook were looked at, even though I thought that they were both private accounts. They found my phone number on a photo of a business card on his Facebook page and rang me suggesting that I was working. Luckily it was for a catering business that never took off as he got another job so could quickly be dismissed. This is not to make you paranoid, but it is best to know that they are looking into you and will try to deny your claim on the slimmest of grounds. All done within the parameters of their income protection plan. Not to worry too much about this but just to be aware of it.”

 

 

 

Newspaper Article

Details of an interesting case in Northern Ireland, where the occupational therapist indicated that the claimant "would be fit to work with an appropriate rehabilitation plan".

‘Ill health forced me to stop work in 2016 and Aviva paid out under my personal health insurance policies. These payments ceased on my 60th birthday last month. I also made a claim under my employer’s policy with Unum because it pays out until the claimant’s 65th birthday. Unum refused to pay the £37,000 gross a year and offered a lump sum of £60,000 instead. I turned the lump sum down as it would have left me with a net amount of £39,000.’

 

Irish Times Oct 25th 2020

Final Thoughts

The bigger picture re recognition/diagnosis/lack of guidelines/financial support (welfare/insurance) with regards to Myalgic Encephalomyelitis

In Ireland and the UK, the myth that ME is a self-perpetuating condition or a ‘mental health’ issue continues to this day in some quarters thanks to the control that a cabal of UK psychiatrists have, and their control of the Science Media Centre in the UK. The SMC controls virtually all the media message relating to ME. It is the same pretty much worldwide. The same cabal have had for a long time and still have control over what is put into the guidelines re therapies for children and adults, and how the clinics operate with regard to ME. The interference by psych in the progress of the development of the recent NICE Guidelines 2021 is a case in point.

 

There are copious amounts of physiological research already carried out that demonstrate that people with Myalgic Encephalomyelitis (ME) are harmed by exercise/activity and therefore to force someone who is diagnosed with ME back to work is to compound that harm and possibly drive them into a situation of total and long-term severe disability.

 

Updates

27/03/24

Please see recently added information re:

• Data Request
• Financial Ombudsman
• Solicitor Support

Data Request (not FOI)

 

Please see information via link on putting in a request if you want to see what information the Insurance company hold about you e.g. reports after any assessment:

 

How to access your personal data under the GDPR (citizensinformation.ie): https://www.citizensinformation.ie/en/government-in-ireland/data-protection/rights-under-general-data-protection-regulation/

 

Sample letter below when requesting information about you:

 

"I, XXX wish to make an access request under section 4 of the Data Protection Act 1988 and 2003 for a copy of any information that you keep about me on computer or in manual form in relation to my claim for Salary/income Protection. Claim number ...."

 

Perhaps a solicitor could do this on your behalf if it is too much to do yourself.

 

We would suggest that you are specific in the data request letter e.g., stating the assessments you had and the names of the assessors so that they do not leave out any information on you re assessments you have already had.

 

 

 

 

 

Financial Ombudsman

 

If you are not satisfied in any way with the outcome of your communications re the insurer with regards to not being fit for the CPAD assessment, or any other future assessment that you are unable to do, you may have recourse to the Financial Services and Pensions Ombudsman (FSPO). Details of the services provided by the FSPO here: https://www.fspo.ie/make-a-complaint/how-to-make-a-complaint-to-the-fspo/

 

The Ombudsman route is long and laborious but is an option for you. If the Insurance company gave you a deadline before which you had to contact the Financial Ombudsman it is likely that the Financial Ombudsmans office would explain more re the deadline..as in you may have more time than the insurance co say.

 

More re the Financial Ombudsman (UK) here wrt Salary Protection which gives more insight to the goings on of Insurance Companies: https://www.financial-ombudsman.org.uk/businesses/complaints-deal/insurance/medical-insurance/income-protection-insurance

 

 

I have scanned the Irish Financial Ombudsman reports online re upholding or rejecting complaints against insurance Cos. re paying income protection. It's a total headache looking at those reports and I am not up to doing more but the ones I have scanned show various outcomes re going the Financial Ombudsman routes (not all ME related though)...looks like a nightmare so a solicitor route may be easier.

 

Here are some of the FO reports; they are difficult to look at, one is about a rejection, the other one a complaint partially upheld. I do remember being told of a case years ago where the FO rejected a complaint (ME related) then fully upheld it later.

 

https://fspo.ie/complaint-outcomes/decisions/documents/2021-0092.pdf

https://fspo.ie/complaint-outcomes/decisions/documents/2021-0334.pdf

 

One of the above cases includes this: "The Provider advises that cover would only have been offered subject to the following exclusion:

 

“No income protection will be payable in the event of a claim arising directly or

indirectly from chronic fatigue syndrome, myalgic encephalomyelitis, fibromyalgia,

anxiety state, stress, mood disorder, depression or any other mental health or

functional somatic disorder.”

 

 

I think a solicitor would argue against the above..not sure how they would do that though. One thing comes to mind...if the Insurance Cos don't include ME in their schemes then perhaps you could expain the disabilities you have that prevent you from working without naming ME...

...a solicitor/other would advise you.

 

Solicitor Support

 

We previously heard of someone who found an article about a lady who won her case ….court case in 2016 taken by a lady, medically retired with ME, against Zurich and that it more or less mirrored individuals with ME circumstances as reported to us. Unfortunately we don’t have further details. If anyone knows of this case please get in touch.

 

 

Previous feedback from someone we had helped in the past who went down the legal route mentions that the person sought the support of a solicitor, i.e., Matthew Byrne at Burns Nowlan Solicitors, 31 Main St, Newbridge, Co.Kildare.

https://bnsolicitors.ie/who-we-are/matthew-byrne/

 

The feedback re the above named solicitor:

 

"I know that I had been in contact with you ages ago about my income protection case. I actually got the name of the solicitor from you through someone else. I had a very positive meeting with them last month. They seemed to know a lot about insurance companies turning down people with ME. They said I had a very strong case but it may take a bit of time because the insurance company will initially push back. They said its crazy that people so ill are being treated so badly by insurance companies. The solicitor I am dealing with is Matthew Byrne."

 

 

No further details re the above unfortunately, we seldom get updates about how individuals got on going down the legal route/other from individuals who have requested help from us, which is unfortunate. 

 

Can you support us with some feedback please?

It would be beneficial

·       to find out if anyone has had success keeping salary protection payments for longer than a few months without being bothered with assessments by the Insurance Co. or about anyone who has managed to keep payments after interval assessments

 

·       to get more up to date information re the rehabilitation therapies that insurance companies are suggesting to people receiving payments and wonder what your experience of that is if it applies to you.

 

·       to find out if anyone had a result where the CPAD assessment supported that they were ill.

 

 Please contact ME Advocates Ireland (MEAI) by email at info@meadvocatesireland.com

 

Many thanks to the people in the ME community and elsewhere who have provided much of the feedback on CPAD assessments and Salary Protection issues over the last years & to one person in particular who went above & beyond with their personal overview & advice 

~