Life, Health & Disability
Contractual entitlement assessed through the medical, functional and occupational evidence.
We represent clients in disputes over benefits under life, health, long-term care, critical illness, disability and personal accident policies. These claims require close reading of the contractual definition of the insured event and careful assessment of the records said to establish it. Our analysis distinguishes a medical diagnosis from the separate requirements for entitlement under the relevant cover.
- Critical illness
- Long-term care
- Disability and incapacity
- Personal accident and life
The insured event and the benefit claimed
We assess the policy definitions, waiting periods, exclusions, benefit periods and other provisions relevant to the claim. In life and health disputes, the chronology of cover, the event and the supporting documentation may be decisive. Where disclosure, pre-existing conditions or the continuation of entitlement is in issue, we identify the factual and legal questions requiring resolution.
Medical, functional and occupational assessment
We analyse the medical record over time, including relevant prior conditions, examinations and expert opinions. For care and disability claims, the evidence of daily functioning or occupational capacity is assessed against the policy’s own criteria. The distinction between clinical findings, medical impairment and ability to perform particular activities or work is maintained throughout the analysis.
Litigation and settlement
We develop the defence around the issues actually in dispute and the evidence needed to determine them. Advice addresses expert questions, the period and amount of benefits claimed, procedural developments and potential settlement. Reporting explains both the strengths of the position and material difficulties in the evidence, so that decisions reflect the claim as it develops rather than the assumptions made at its outset.