Getting rich on disability denial

Debbie Jolly reports on US insurance giant Unum, whose ‘biopsychosocial model’ is being used to justify the devastating cuts in disability benefits
February 2013

When the Tory work and pensions undersecretary Lord David Freud set out his vision of welfare reform for disabled people he used a number of references to back up his plans. No fewer than 170 of these references came from a group of academics based at or connected to Cardiff University’s Centre for Psychosocial and Disability Research.

This centre, originally led by the ex‑chief medical officer at the Department for Work and Pensions, Sir Mansel Alyward, was funded by the US-based insurance giant Unum to the tune of £1.6 million from 2004 to 2009. The objective was to add academic credibility to the ‘biopsychosocial model’ that has underpinned disability benefits reform since the early 1990s – a model used as part of the government’s disability benefits crackdown by the private company Atos in identifying who is deemed to be ‘fit for work’ and hence ineligible for disability support.

So what is the biopsychosocial model? In this context, its key postulate is that an emphasis on medical causes and effects has failed to provide an adequate basis for disability benefits policy, and therefore much greater emphasis should be placed on the psychological attitudes and beliefs of individuals. It posits that disability – and the ability to work in particular – is not just a medically definable, physical matter but one that has a social and psychological dimension too. And it is used to underpin the assertion that to a very large extent the growth in the cost of disability benefits must surely be the result of people faking those disabilities.

A whole set of workshops run by Unum with such charming titles as ‘Malingering and illness deception’ should leave us in no doubt about where this approach is coming from. A glance at popular media would appear to substantiate such a view. However, the headline figures of those considered ‘fit for work’ by Atos always miss the successful appeals at tribunal, which significantly reduce those figures (and incidentally cost the taxpayer £50-80 million per year). Who is gaining from this system?

Unum’s second vice-president John LoCascio was brought into UK government circles as early as 1992 to ‘manage’ incapacity benefit claims. He was also responsible for bringing in ‘health assessors’ and training them by Unum criteria in biopsychosocial views of individual capacity. Back in the US this approach led to the company (which currently provides disability insurance for 25 million workers, half the US market) systematically refusing to pay out on huge numbers of insurance claims. One of its working practices that received widespread negative attention involved rewarding employees with ‘hungry vulture awards’ for their success in closing claims.

Unum’s behaviour resulted in it being accused of being ‘an outlaw company – it is a company that for years has operated in an illegal fashion’ by California insurance commissioner John Garamendi in 2005, when it was charged with more than 25 violations of state law and fined $8 million. These charges followed a financial and regulatory settlement in the previous year with 48 US states following investigations of Unum’s alleged abuses.

Nevertheless this same basic approach was to prove useful in helping with the UK’s welfare reform and in overriding the basis of medical opinion as the deciding factor on a whole set of conditions. And the more the government bought into disability denial with its contracted private companies such as Atos and supporting academics, the more Unum stood to benefit from increased market returns on its insurance business as disabled people saw their minimal welfare support diminishing.

The company was quick to seize its opportunities. As early as 1997, with the roll out of the all work test to assess fitness for work for benefit purposes, in which John LoCascio had played a major part, Unum launched an expensive advertising campaign. One ad ran: ‘April 13, unlucky for some. Because tomorrow the new rules on state incapacity benefit announced in the 1993 autumn budget come into effect. Which means that if you fall ill and have to rely on state incapacity benefit, you could be in serious trouble.’

Unlucky for some, lucky for Unum.


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Chris 26 February 2013, 20.35

The biopsychosocial model of illness has been used so effectively to in the denial of M.E. (Myalgic Encephalomyelitis), in favour of a definition of idiopathic fatigue with ill defined symptoms and calling it CFS. It’s cheaper to do psychological research and so much cheaper to treat it with brainwashing CBT for 6 sessions, which seeks to play down the nature of your illness and tells you can recover by thinking you can and changing your behaviour (exercise/increased activity until you get back to work.) Nice agenda driven approach. It started with the insurance industry: It was cheaper to deny the lifelong neurological illnesses that got permanent ill health payments, in favour of psychological disorders that you can possibly recover from.

lisa brady 27 February 2013, 06.51

Chris’s is so spot on CBT is a deffinate f.orm of brain washing for those not trained to provide adequate councelling.can be taught in two hours for a 6 week course then let lose on the most vulnerable not clinicly supervised can be carried out by anyone.

joe kane 27 February 2013, 07.51

There is a form of CBT which is used on vulnerable patients by medical authorities to brainwash their victims into ignoring their symptoms and to imagine there is nothing wrong with their health.

Angela Kennedy has recently publish a book which explains these institutionalised iatrogenic abuses. See Chapter 6 Think yourself better in her ‘Authors of Their Own Misfortune? The Problems with Psychogenic Explanations’ (2012).

The excellent Tom Kindlon of the Irish ME/CFS Association, in an recent interview explains that CBT, and its usual accompaniment GET, have never been properly tested or evaluated for harm done to patients –
Cort Johnson interviews Tom Kindlon (Introduction)

The DWP ESA regime presumes that it is BPS psychosocial problems of patients which are preventing them getting back to work, not their actual real physical diseases and disabilities. Under the pseudo-scientific medical quackology behind the unethical ESA regime, disabled patients are automatically assumed to have become mentally deconditioned and psychologically demotivated, and just giving them welfare benefits, inappropriate sympathy and suchlike merely perpetuates this baleful situation. Some CBT/GET in the form of a ESA WRAG mandatory work scheme will soon get them back on their feet and into the right frame of mind to enter the job market once again.

At this point in time, the £5 million PACE Trial Study which was partly funded by the DWP, and the only such medical study it has ever funded, has run into trouble trying to justify the efficacy and harmlessness of CBT/GET. PACE was a means to justify the DWP’s BPS model of disability denial and has fallen flat on its face.

Quite where the British medical mandarin establishment governing authorities are in all this unfolding BPS disaster, which has engulfed the whole of the British long-term sick and disabled patient community, still remains to be seen. How the medical science the DWP uses to justify its ESA regime managed to pass the peer review process is a mystery. As is the medical establishment’s silence on the now vast amount of evidence that professional medics working for the DWP and Atos are taking part in an unethical anti-medical process which is harming and traumatising vast numbers of sick and disabled people in Britain with, as yet,no end in sight.

jacquie perrie 27 April 2013, 12.15

Many of us are aware of what they are doing. How can we stop this despicable abuse!

Comments are now closed on this article.

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