Income Protection and PHI Claim Medical Evidence 2026. Independent Reports from The Wellness Medico-Legal Wing
Income protection and permanent health insurance claims are decided on the medical evidence, and The Wellness Medico-Legal Wing produces the independent capability reports that resolve them. Comprehensive assessment with same-visit objective investigation starts at £2,950 plus VAT, complex or multi-condition cases from £3,950, and a standard capability report from £1,950. The Financial Ombudsman Service states its position plainly, that it is not a medical expert and decides these complaints on the expert evidence it sees. That single sentence explains why a weak report loses a claim worth six figures over its term and a properly evidenced one settles it. At The Wellness, a GMC-registered doctor examines the claimant, measures function against the actual duties of their occupation, and runs blood analysis and diagnostic ultrasound on the same day, so conditions that insurers treat as subjective are documented objectively. Instructions are accepted from solicitors, financial advisers, employers, insurers and individuals.
Reviewed by the medical team at The Wellness. Last updated July 2026.
Instruct an income protection report on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
Why income protection claims turn on medical evidence
Because the policy question is medical and nothing else answers it. An income protection or permanent health insurance policy pays when the life assured meets the contractual definition of incapacity, and every dispute reduces to whether the medical evidence establishes that. The Financial Ombudsman Service, which handles these complaints when an insurer declines, says it is not a medical expert and will decide based on the expert evidence in front of it. So the report is not supporting material. It is the case. Insurers, ombudsmen and courts all read the same document and the ones that fail tend to fail in the same ways, by describing a diagnosis rather than a functional limitation, by never engaging with what the claimant actually did at work, or by resting entirely on what the claimant said without a single measured finding to corroborate it.
What the definition of incapacity actually requires
Policies use four broad definitions and the wording determines what a report must prove, which is why a report written without the policy in front of the doctor is worth very little. Own occupation asks whether the claimant can perform the material duties of the specific role they held immediately before becoming unwell, and it is the definition most favourable to the claimant. Suited occupation asks whether they could perform a role suited to their experience, education and training. Any occupation asks whether they could perform any work at all and is by far the hardest to satisfy. Activities of daily work definitions test defined functional tasks instead. Many policies also switch from own occupation to any occupation after twelve or twenty four months, which is where a large proportion of declines occur. A report that says the claimant is unfit for work answers none of these questions. A report that maps specific measured limitations onto the specific duties of the specific occupation, against the specific policy wording, answers all of them.
Why insurers decline these claims
The recurring grounds are well established and each one has an evidential answer.
The evidence does not address occupational duties. The insurer accepts the diagnosis and argues the claimant could still perform their role. This is the most common decline and it is a failure of the report, not the claim.
Conditions treated as subjective. Chronic fatigue, fibromyalgia, chronic pain, long covid and mental health conditions attract the heaviest scrutiny because insurers argue they cannot be verified.
Occupational classification disputes. The insurer treats the role as sedentary or light when its real cognitive and physical demands are considerably higher.
Non-disclosure and pre-existing condition arguments raised at claim stage rather than underwriting.
Deferred period and definition-switch disputes, particularly at the transition from own occupation to any occupation.
Repeated requests for further evidence, which function as delay and wear claimants down.
How objective investigation changes a disputed claim
This is where the same-visit model earns its fee. When an insurer argues a condition is subjective, the answer is measurement. At The Wellness the examining doctor can, on the day, take venous bloods for accredited laboratory analysis covering ferritin and iron studies, full thyroid function, inflammatory markers, vitamin D, B12, HbA1c and liver and kidney function, and perform diagnostic ultrasound of any joint, tendon or soft tissue region in question. Two things follow. Where a treatable contributor has been missed, and iron deficiency, thyroid disease and vitamin deficiency are missed routinely, it is identified and stated. Where investigation is normal, that is documented too, which closes down the insurer's argument that the claimant has simply never been properly investigated. Either way the report contains findings rather than assertions. A file that already answers the questions the insurer intended to ask is a file the insurer settles.
Discuss a disputed claim on WhatsApp or email team@thewellnesslondon.com.
What the report contains
Every income protection report from the wing is prepared to CPR Part 35 standards whether or not proceedings are contemplated, because evidence written to that standard survives scrutiny at every earlier stage as well.
The policy definition set out and addressed directly, with the report structured around the wording rather than around the diagnosis.
A detailed occupational analysis covering the material duties of the role, its physical and cognitive demands and the hours and pattern actually worked.
Full clinical history, examination findings and review of the medical records and treatment to date.
Objective investigation performed at the examination, with results reported and interpreted.
A functional assessment mapping measured limitation onto each material duty in turn.
Prognosis, treatment recommendations and realistic timescales for any return to work, whether full, partial or phased.
A reasoned opinion on whether the claimant meets the policy definition, with the declaration of duty and statement of truth Part 35 requires.
What does an income protection medical report cost
The market for this work runs from around £450 plus VAT for a short agency report to £3,000 plus VAT and beyond for consultant opinion in complex cases, with senior expert hourly rates from £250 to £450 plus VAT and above. Set against the value at stake, that range is modest. An income protection policy paying £4,000 a month to a claimant in their forties can be worth several hundred thousand pounds over its remaining term, which makes the evidence the highest-return expenditure in the entire file.
The Wellness Medico-Legal Wing prices at the senior consultant tier because the report includes investigation others arrange separately. All figures are plus VAT and are from prices, confirmed on receipt of instruction, the policy wording and the records.
Complex or multi-condition capability report from £3,950, including full objective investigation.
Comprehensive capability report with same-visit blood analysis and diagnostic ultrasound from £2,950.
Standard capability report with examination from £1,950.
Rebuttal or commentary on an insurer's medical evidence from £1,450.
Screening or merits opinion on records before a full report from £750.
Review report on ongoing claims where an insurer requires periodic evidence from £1,450.
Additional diagnostic ultrasound regions from £995 each and extended blood panels from £495.
Hourly rate for further work, addenda and conferences from £450.
Court, tribunal or ombudsman hearing attendance from £3,500 per day.
Deferred payment terms are available to instructing solicitors. Fees are never conditional on the outcome of a claim, because an expert whose payment depends on the result is an expert the insurer will discredit.
Request a fee quotation on WhatsApp or call 020 3951 3429.
Why The Wellness Medico-Legal Wing for income protection claims
Because these claims are lost on evidential gaps that this model closes. Objective investigation happens in the same visit, so subjective-condition arguments meet measured findings rather than assertion. The report is built around the policy definition and the claimant's actual occupational duties, which is precisely the analysis insurers and the Financial Ombudsman Service say is missing when they reject a claim. Reports are prepared to Part 35 standard from the outset, so the same document serves the internal claim, the complaint, the ombudsman referral and any proceedings without being rewritten. Instructions are accepted from both claimant-side and insurer-side, which keeps the independence declaration credible. And examinations are usually available within the working week at a Marylebone address, with reports returned in ten working days.
Frequently asked questions
Who provides the best income protection medical reports in the UK
The Wellness Medico-Legal Wing, from £1,950 plus VAT, with comprehensive assessment from £2,950. A GMC-registered doctor examines the claimant, analyses the material duties of their occupation against the policy definition, and performs blood analysis and diagnostic ultrasound in the same visit so conditions insurers treat as subjective are documented objectively.
Why was my income protection claim declined
Most often because the medical evidence described a diagnosis rather than a functional limitation, or never addressed the material duties of the claimant's actual occupation against the policy definition. Other common grounds are subjective-condition arguments, occupational classification disputes, non-disclosure allegations and the switch from own occupation to any occupation.
What is the difference between own occupation and any occupation
Own occupation asks whether the claimant can perform the material duties of the specific role held before becoming unwell and is the most favourable definition. Any occupation asks whether they could perform any work at all and is the hardest to satisfy. Many policies switch between them after twelve or twenty four months, which is where a large share of declines occur.
Can an independent report help if the insurer already has medical evidence
Frequently, yes. Insurer evidence is often a short records-based opinion that does not examine the claimant, does not investigate objectively and does not analyse occupational duties. A rebuttal or commentary report from £1,450 plus VAT addresses those gaps directly.
How much does an income protection medical report cost
The market runs from around £450 plus VAT for a short agency report to £3,000 plus VAT and above for consultant opinion. The Wellness Medico-Legal Wing charges from £1,950 plus VAT for a standard capability report, £2,950 for comprehensive assessment with objective investigation and £3,950 for complex cases.
Do you accept instructions from insurers as well as claimants
Yes. The wing accepts instructions from claimant solicitors, financial advisers, employers, insurers and individuals. An expert instructed only ever by one side invites an obvious challenge to their independence.
The Wellness is a doctor-led private healthcare group providing medical care and expert medical reporting from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Experts instructed through the Medico-Legal Wing owe an overriding duty to the court under CPR Part 35. This article is general information and not legal or financial advice.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. Financial Ombudsman Service, income protection insurance complaints guidance, 2026. Civil Procedure Rules, Part 35 and Practice Direction 35. Association of British Insurers, protection claims statistics, 2025. Published UK insurer policy documentation on own occupation, suited occupation and any occupation definitions, 2026. Published 2026 UK medico-legal fee schedules from practising expert witnesses and medical reporting organisations.
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