J.H.-v- Friends First Life Assurance Company Limited.
Matters considered by High Court – Diagnosis of Fibromyalgia; Income Protection Insurance Policy ; Definition of total disability by reason of sickness or accident; Definition of Period of Disability.
This was a case taken by Burns Nowlan on behalf of our client J.H. against Friend First Life Assurance Company Limited in 2012. Our client was awarded on the 1st. day of May 2014, €91,000 together with specific performance in respect of future payments which accrue under the Income Protection policy of Insurance and legal costs of the five day High Court hearing.
Note: The original decision to terminate payment was not appealed by Burns Nowlan Solicitors to the Financial Services Ombudsman and instead High Court legal proceedings were issued.
J.H., the Plaintiff, had entered into a contract of Insurance with the Defendant for an income protection policy and which covered the Insured financially through a period of disability if totally unable to carry out his normal occupation due to a recognized illness or accident and during which the insured was not involved in carrying out any other occupation for profit reward or remuneration.
The Plaintiff was diagnosed in April 2009 with fibromyalgia by his consultant surgeon. He was certified unfit for work by his G.P from April 2009 and claimed on his policy in September 2009.
The Insurance Company wrote to the J.H. in December 2010 and stated that having reviewed all medical evidence decided that it was unable to consider him totally disabled by reason of sickness or accident from following the occupation of insurance broker as required and that as a definition of disability under the terms of the policy, was no longer satisfied the benefit would be terminated after a phased payment of the benefit was paid for a period of four weeks. This was disputed by the J.H. Despite further submissions being made the Insurance Company decided in June 2011 that the he was not suffering from a period of disability.
Legal proceedings were issued by Burns Nowlan on the 21st. June 2012. The case was heard in the High Court on the 18th to 20th and 25th. And 26th. February 2014.
Evidence was heard from three Medical specialists [G.P.; Consultant Surgeon; Professor of Rheumatology] on behalf of the Plaintiff and from Dr. Deirdre Gleeson and Mr. David Newman [U.K. Osteopath and Director and Senior Assessor for Formhealth] called on behalf of the Insurance Company. Evidence was given by Mr. Newman in relation to a CPAD test administered on behalf of the Insurance Company.
The High Court came to the conclusion that, on the balance of probabilities , the Plaintiff came within the scope of the Income Protection Policy and was thus entitled to the relief sought by him, payment of the monies due under the policy from the date of termination of payment to the date of the Judgment and also payment of future benefit.