Permanent Health Insurance
Expert psychiatric evaluation of Permanent Health Insurance claims — providing a forensic analysis of a claimant’s functional capacity and vocational suitability. We offer robust, evidence-based assessments for litigation and FOS disputes with urgent reports available in 1-4 days.
Expert Type
- Consultant Forensic Psychiatrist
- Clinical Psychologist
- Neuropsychologist
- Occupational Physician
Applicable Law
- Civil Procedure Rules Part 35
- Insurance Act 2015
- Equality Act 2010
- Financial Services and Markets Act 2000
- Consumer Insurance (Disclosure and Representations) Act 2012
When Needed
Assessments are essential when a claimant’s mental health prevents them from fulfilling their contractual duties or when an insurer disputes the level of psychiatric disability.
What Is a Permanent Health Insurance Assessment?
A Permanent Health Insurance assessment is a specialized forensic evaluation conducted to determine if a claimant meets the policy’s definition of total or partial disability. These reports bridge the gap between clinical diagnosis and the contractual requirements of income protection policies, focusing specifically on how psychiatric symptoms impair work-related functioning.
The assessment applies the legal test of incapacity as stipulated in the insurance contract, often distinguishing between the inability to perform “own occupation” versus “any occupation”. Our experts provide a definitive opinion on whether the psychiatric condition is the primary cause of the loss of earnings and evaluate the potential for future recovery.
- Policy interpretation — aligning clinical findings with specific “own” or “any” occupation definitions
- Functional impairment — detailed evidence of how psychiatric symptoms prevent specific occupational tasks
- Treatment adherence — evaluating whether the claimant has engaged with optimal medical management
- Symptom validity — rigorous testing to ensure the reported psychological distress is consistent and genuine
- Transferable skills — assessing the claimant’s ability to pivot to alternative roles based on education and experience
- Prognostic outlook — a clinical forecast regarding the expected duration of occupational incapacity
These assessments are typically commissioned by solicitors or insurers to provide objective evidence during litigation or Financial Ombudsman Service (FOS) appeals. The expert must maintain independence and impartiality, ensuring the report withstands the scrutiny of cross-examination or regulatory review.
By synthesising medical records, occupational health data, and direct clinical examination, the expert delivers a comprehensive forensic opinion. This evidence is critical in determining the quantum of loss and the validity of long-term disability payments under the policy terms.
Key Assessment Components
Our assessment evaluates the following areas:
Clinical Interview
A comprehensive examination of the claimant’s psychiatric history and current mental state to establish a formal diagnosis.
Occupational History
A detailed review of the claimant’s professional responsibilities and the specific points of functional failure.
Records Review
Analysis of primary care, specialist psychiatric, and occupational health records to identify clinical trends.
Psychometric Testing
The use of standardized tools to measure cognitive function and screen for malingering or symptom exaggeration.
Treatment Review
Evaluation of past and current therapeutic interventions to determine if recovery has been maximized.
Vocational Capacity
An expert opinion on the claimant’s ability to perform alternative employment or return to their original role.
Conditions That May Affect This Assessment
A range of psychiatric and psychological conditions can affect this assessment. These include:
The clinical presentation of these conditions can fluctuate, requiring an expert to assess consistency of impairment over time.
Assessment Process
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Instruction Received
We receive formal instructions from solicitors or insurers outlining the specific policy definitions and key questions to be addressed.
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Expert Matched
We assign a consultant psychiatrist or psychologist with specific expertise in insurance claims and occupational forensic assessment.
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Assessment Conducted
A thorough clinical interview and psychometric evaluation are conducted, either in-person or via secure video link.
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Report Delivered
A CPR Part 35 compliant report is delivered, providing a clear opinion on disability status, prognosis, and vocational capacity.
Turnaround Times
| Urgency Level | Timescale |
|---|---|
| Standard Report | 4-6 weeks from assessment |
| Priority Report | 1-2 weeks |
| Urgent Report | 1-4 days |
What’s Included in the Report
Our reports are prepared to the highest forensic standards and our experts are fully trained in providing oral testimony for court or tribunal hearings.
Frequently Asked Questions
Need a Permanent Health Insurance Report?
Contact our expert witness team today for CVs and quotes delivered within 60 minutes for your insurance litigation needs.
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