A complex and perplexing problem, but one that, given the will, could be resolved within the ambit of the Rules of The Fund.
Public fora such as Pprune are not really a proper or satisfactory place to be discussing these matters, however given the secretive nature of the Administration of the Fund, and their refusal to allow closed access to the membership, I can understand Mark’s finding it necessary to come to this place.
Fmcinop stated
The problem is surgery from what I read might fix the problem. While that is the case the MBF cannot make payment. The trustees are legally bound by the rules and would have had their own medical advisors and lawyers look at the case.
Close but no cigar.
The Trustee, through the Board “ shall do all such acts and things as may be necessary for the carrying out of the objects of the Fund” (Rule 14 (b) (vii))
The object of The Mutual Benefit Fund is to provide financial assistance to any of it’s members whose earning capacity as a pilot has ceased or has been downgraded due to a temporary or permanent suspension or cancellation of their Class 1 Medical certificate……………” ( Rule 1 (b) )
Many years ago, the then Trustees of the Fund at a meeting with the Fund’s lawyers, received advice that; basically the discretionary powers embodied within the Rules of the Fund are wide ranging and that in effect the Trustees can apply the rules in any way they see fit, provided that such application is to the benefit of the Fund and its members and that it is not applied /conducted , in a capricious manner. My recollection is that Mr Charlesworth ( current Board member ) was at that meeting along with myself and others.
Rule 7 (f)(iv)of the fund states, inter alia: “ Notwithstanding anything herewith contained to the contrary the Trustee may in their sole and absolute discretion make a lump sum payment to a Member of the Member’s entitlement or so much of such entitlement as remains unpaid in final satisfaction of such Member’s entitlement at the end of 15 months from the date of the commencement of the disability, where the Trustee in consultation with the Medical Advisers to the Fund, decide that the suspension or cancellation of the Member’s Class 1 Medical Certificate is unlikely to be removed……………………”
Rule 8 (a) states: “ Where the suspension or cancellation of a Members Class 1 Medical Certificate has not been removed after a period of 15 months from the commencement date of the disability and it has been firmly established to the satisfaction of the Trustee, after due consultation with the Fund’s Medical Advisers that such suspension is permanent, then the balance of the Capital Benefit to which the Member is entitled shall be paid forthwith………………………….
Rule 7 (l) states ……………..”Both the commencement and continuance of such benefits shall be conditional upon satisfactory evidence being provided to show that the Member is taking all reasonable steps to have the disability rectified and the Class 1 Medical Certificate restored.
From discussion with Mark I have gleaned the following.
His condition is such that he does not meet the criteria for the continuation of his Class 1 Medical. CASA agree and have refused to issue a certificate.
His cardiologist has stated that his condition is not suitable for the use of stents.
Presently his condition is controllable with medication, but the underlying problem remains.
CASA will not re-issue a Class 1 while he is on medication alone.
Untreated or un-medicated his condition will deteriorate.
He could undergo surgery that may possibly slow or halt his deterioration.
Surgery is unlikely to permanently restore his function to the standards required to regain his Class 1 medical
Surgery at this juncture would expose him to more risk than he would endure in the absence of surgery.
His cardiologist has declined to recommend him for surgery at this stage.
He has gained two other opinions (one from an MBF designee) and neither of them has contradicted the original opinion, prognosis, or treatment.
As with any member, Mark is required to take all “reasonable “ steps to return his status to that which would lead to his Class 1 status being restored.
Is it reasonable to expect a member to go against the advice of his (and other) cardiac specialists, to put himself into a life threatening situation, on the off chance that the procedure that entails significant medical dangers, might give some, possibly, temporary respite to his condition?
Given that his cardiologist has declined to recommend surgery (at this point), how is he supposed to secure this risky surgery. Perhaps the Trustee might be happier if he went off to India or China to secure a procedure.
Mark has previously asked the Fund Manager if the decision not to process his Capital payout was as a result of an assessment by the Fund Medical adviser Dr Rob Liddell. No satisfactory answer was received. Just an indignant enquiry as to how he knew that Dr Liddell was the funds medical adviser. (News time guys, I told him. Have a problem with that?)
If indeed this decision is the result of an assessment by the Fund’s Medical adviser, is he qualified to overrule the opinions stated and implied, by three cardiologists, that surgery is not currently advised. Is Dr Liddell a cardiac specialist also?
If Mark were to undergo surgery, CASA , (unless the game rules have changed) would probably require a 2 year symptom free period before granting a Class 1 medical certificate.
Given that this has been going on for some 21 months already; lets say 6 months to get surgery organised (non life threatening ailment in the short term therefore low priority in the public health system), then a 24 month symptom free requirement for CASA; we are up to a total of 51 months from go to whoa.
And for an uncertain outcome, with life threatening risks along the way. In the event that his medical was not restored at that point, the Trustee would, under the rules, be obliged to make a determination, at 60 months as to whether or not the medical loss was deemed to be permanent.
In the meantime the Fund will be obliged to keep the Member on drip feed of 1% of Capital benefit per month. Given his parlous financial state, Mark has requested that the Trustee consider making a capital payment, which would could be used far more effectively to secure his welfare, than could the drip feed.
Mark has offered a legally binding undertaking that in the event that his medical be restored he will repay in full any funds to which he is not entitled. No response has been received to that concept.
I would put it that Mark has taken all reasonable steps to secure his medical status, but that the Trustee has been unreasonable and capricious in its application of the rules, which clearly give the flexibility to the Trustee to act for the benefit of a member.
The Trustee has the opportunity to assist a member at a time of drastic need, but has failed to rise to the challenge, in direct contravention of the spirit of Rule 1 of the Fund
In nearly 40 years with the fund, on the basis of the information that has been given to me, this would appear to be the most disgraceful and I believe capricious handling of a member’ claim that I have witnessed.
My questions to the Board would be:
Do you consider that the claimant has taken all reasonable steps to regain his medical status?
If YES. Have you explained in lay terms, why he is ineligible for a payment in accordance with 8 (a)
If NO. Do you consider, that unless the claimant is prepared to undergo a life threatening procedure, he is non-compliant with Rule 7 (l)? If so he is ineligible for further payments and you should cease his drip feed forthwith, (If not why not); and further
If NO. Given that his cardiologist has stated that surgery is contra-indicated at this point in time, what guidance have you provided the claimant, and what further steps can he take?
Is the Board’s lack of conviction that this is a “permanent loss” based on the advice of Dr Liddell, or is it an opinion formed by a majority of the,( non medically qualified), Board members, irrespective of medical advice?
If this decision was based on the advice of Dr Liddell, is he better qualified in cardiac matters, that the claimant’s two cardiologists and the AAPMBF nominated cardiologist? (Dr Liddell is a respected medical practitioner and this should not be construed as a challenge to his professional competence or reputation, just to his relative expertise)
If Dr Liddell is of the opinion that it is not possible to conclude that the loss of medical standard is permanent, he must surely be able to codify what could change to restore the claimant’s medical status. And the claimant advised accordingly. If he is not able to do so, the never say never philosophy should apply to all claimants.
For those who are about to leap on their keyboards and say take it up with the Board, I am just about to do that. My purpose in persuing this in this forum is that th Administration of the AAPMBF is a secret society and without this sort of forum members will have no knowledge other than that which is feed through the system. If the AAPMBF were an open organisation where members could communicate with members, posts such as these would not be necessary, and everyone would be much happier talking behind closed doors. Think about it Dave.