An Interview with Eric Sloane
UPdate Fall 1999

     Question:I have Environmental Illness. Why does my insurance company not believe that I
am really sick?

     Answer:   There are many reasons why many insurance companies are skeptical about
Environmental Illness.  First of all, it is only fairly recently that physicians have been making a diagnosis of Environmental Illness, and - as with anything new - not everyone is ready to accept it as a valid diagnosis.  Insurance companies rely on their own medical consultants, many of whom are skeptical and conservative, by nature.  As  Environmental Illness becomes more accepted by the mainstream of the medical profession, it is bound to be taken more seriously by insurers.

     Secondly, the symptoms of Environmental Illness are largely  self-reported.  So are other conditions, such as chronic pain, soft tissue injuries, chronic fatigue and others.  Patients with these conditions also experience a certain amount of skepticism from insurers, who frequently take the position that, since a condition is "merely subjective", and cannot be "objectively" verified, that it 
does not meet their criteria.

     Thirdly, you may be experiencing a situation common to many disabled people - the insurance companies tend to interpret their own policy definitions  of "total disability" so strictly that many very sick and disabled people are nevertheless considered fit for some work.

     I take issue with the insurers on all counts.  First of all, they should read their own policies.  There is nothing in any policy that I have seen which requires a claimant to have a condition that has been recognized by medical science for a long time;  indeed, there is nothing that says that a firm diagnosis must have been made.  Most policies require a claimant to be suffering from an illness 
or injury that prevents them from working, and to be under the regular care of a physician.  It is up to the physician to decide on a diagnosis, or not.  If there is a controversy within the profession about Environmental Illness, that is for the professionals to fight about.  It is a fight that should not be fought on the backs of sick people.

     Even if Environmental Illness is later found to be something different from what doctors currently believe, that would not change the fact that people are really sick - with something!

     Also, there is nothing in disability policies that requires the illness to be objectively verifiable.  Since most insurance claims are decided by people in offices who rarely, if ever, get to see the actual sick person, it is understandable that they feel more justified in allowing claims where there is solid evidence of something wrong.  But in cases where that evidence is simply unavailable, because of the nature of the condition, it is my view that they just have to go a little further and acquire evidence of a different character.  If the medical reports are not sufficiently informative, they should have someone pay a visit to the claimant, and perhaps talk to friends or family members, who can often vouch for how disabling a condition is.

     This raises a question about medical reports.  Since insurers are so dependent upon a paper trail, it makes sense to supply them with the best paper possible.

     Doctors should be encouraged to write more informative (and legible!) reports.

     Often, that will be the difference between a successful claim and a denied one.

     The fact is that many doctors are too busy to pay much attention to reports, and some of them are simply not good at it.  However, they must be made to understand that a very important part of their function is to communicate the patient's condition to the official world - insurers, government etc.  
I see it as a part of the healing function.  Many of my clients' conditions have been made so much worse by the financial and other stresses of a failed disability claim, and it is at least partly within the ability of doctors to help alleviate that suffering.

     Lastly, insurance companies sometimes forget that they are in the business of selling security.  People rely in good faith on the coverage that suddenly vanishes when it is most needed.  They are met with allegations that their conditions are not serious enough to keep them from working; that (surely) they could do something!  Often, claimants have their own efforts to get well thrown back in their faces: eg.  "If you are well enough to take walks, exercise and look after yourself, you are well enough to work."  This attitude forgets that the first priority should be to get better.  Most Environmental Illness sufferers have a limited amount of energy, and if they are ever going to get better they need to put that energy into working for their own recovery.  There is also the issue of avoidance of exposure, which many companies do not understand.  Many of them believe that totally safe environments exist, or can be created without too much difficulty.  Many of you know how elusive the "safe environment" really is.

     I guess the bottom line is that insurance companies are in the business of making  money, and claims are very costly.  Every claim that is denied saves them a lot of money.  I am speculating here, however I suspect that they probably count on the fact that a certain proportion of people whose claims are denied will not have the energy or resources to fight back.