Following his previous article on top tips for making insurance claims following serious injury or illness, paralegal Charlie Blair recounts a real-life case study of how our pro bono team utilised these tips to recover a substantial sum for a catastrophically injured client.

Charlie and Personal Injury team partner Charles Edwards met Wayne* through the Royal National Orthopaedic Hospital legal service in November 2023. Wayne had sustained a severe spinal cord injury as a result of a sporting incident whilst on a family holiday. His spinal cord injury was classified as a C4 ASIA C injury, which meant the injury was ‘incomplete’ and the spinal cord was able to send some messages to the brain. However, Wayne had nonetheless lost sensation and function in all four of his limbs.

 

Initial insurance claims

Wayne had numerous financial liabilities and was concerned about his future financial security. He discovered through his workplace’s HR team that he had two insurance policies, a critical illness policy and a personal accident policy, as employee benefits. Wayne submitted claims himself under both policies.

The first insurer made a one-off payment of £2,000 to Wayne but stated they do not cover spinal cord injuries. Both insurers then argued that Wayne’s medical notes said he was ‘unlikely’ to fully recover, and therefore the insurers concluded he might be able to make a full recovery and therefore could not claim. They would not review their position for 12 months, during which time Wayne would continue to have the same concerns regarding his finances.

 

Pro bono team assistance

Our team conducted a thorough review of the insurance policies, paying close attention to the definitions, to ensure Wayne could recover the maximum amount under both policies. In light of the severity of Wayne’s injuries and his need for financial assistance, we recommended that Wayne should pursue the claim immediately and not wait for 12 months.

We reviewed both of the policies to ensure Wayne could recover the maximum amount and then wrote to Wayne’s consultant outlining the precise wording from the policy that he needed to meet, stressing the importance of terminology such as “total and irreversible”.

After obtaining and reviewing the consultant’s report, we liaised with them to ensure it was as tight as possible and that the insurer would have no means of challenging it. We then submitted a letter to both insurers.

Wayne thereafter received further payouts from the insurers totalling £330,000.

 

Testimony

Wayne said: “The free legal service provided by Stewarts was crucial for me, as spinal cord injury is not just complex in its own right but complex for insurance companies as well. At a time when I wasn’t in the headspace to navigate my personal accident and critical illness insurance claims, both of which the insurers were initially refusing to pay out, Stewarts were able to step in and lift the burden off my shoulders. They provided the guidance and legwork necessary to get the documents that my insurance companies needed to see for my claims to be honoured.

I fear that if it wasn’t for Stewarts’ help I would either still be chasing my insurers or have achieved a much worse outcome myself. I am very grateful for everything they have done for me and would highly recommend their services to any other SCI patient.”

*name changed to preserve anonymity

 


 

You can find further information regarding our expertise, experience and team on our Personal Injury and page.

If you require assistance from our team, please contact us.

 


 

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