Consultation has started on a new ABI guide to functional assessment tests (FATs), which seeks improved understanding by consumers comparing IP, CI and LTC policies and by claims managers dealing with claims.
The guide explains how FATs are broken into two groups of tests – activities of daily living (ADLs) and activities of daily working (ADWs) - and includes a checklist for comparing policies.
This list, intended for consumers and their advisers outlines issues of:
“Generally the more activities available to be tested, the easier it is to make a successful claim,” the document states.
Among the advice for claims managers in the guide is reference to mental impairment and degree of impairment that must be considered in relation to any claim.
This point arises because regardless whether or not policies include specific wording relating to mental impairment, “an inability to perform one of the functional criteria because of a mental, organic brain disease or brain injury impairment would still mean that that criterion would be satisfied unless explicitly excluded.”
The guide also stresses that any wording “must be interpreted and applied reasonably”, especially with regard to disabled people looking to “continue as normal a lifestyle as possible.”
”Therefore claimants who can only satisfy a particular criterion through extraordinary effort or perhaps whilst enduring considerable discomfort or pain may well, depending on the circumstances of the claim, be entitled to payment of benefit. “
The deadline for submissions to the consultation is 31 December.
Submissions should be send to Richard Walsh, Head of Health, Association of British Insurers, 51 Gresham Street, London, EC2V 7HQ, or emailed to [email protected]IFAonline
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