Go Back  PPRuNe Forums > PPRuNe Worldwide > Middle East
Reload this Page >

LIPS / API CLAIM DENIED

Middle East Many expats still flying in Knoteetingham. Regional issues can be discussed here.

LIPS / API CLAIM DENIED

Old 8th Mar 2018, 14:32
  #221 (permalink)  
 
Join Date: Mar 2018
Location: Dubai
Posts: 7
Likes: 0
Received 0 Likes on 0 Posts
Hi Gardenshed.

I didn’t actually see a question in here. In order to include ‘extreme sports’ as an exclusion, we’d have to define it. Emirates defines skiing and kayaking as extreme sports. I'm a skier; I do not consider it to be an extreme sport. It’s not our job to tell people how to live or to penalize them for their life-style choices.

In regards to the “self-reported” disabilities, we didn’t make that list, we asked medical and risk-assessment professionals to come up with one.
Switchboard is offline  
Old 8th Mar 2018, 14:37
  #222 (permalink)  
 
Join Date: Mar 2018
Location: Dubai
Posts: 7
Likes: 0
Received 0 Likes on 0 Posts
Hello Payscale. Sorry it took so long to get back to you. I’m currently on a layover.

I don’t know when you joined, but when LIPS first started there were no restrictions, except pre-existing condition or suicide (obesity and smoking were added but then deleted as being too vague); but it was a different time at Emirates when pilots stayed until retirement. They were just being pilots and not everyone was an amateur lawyer looking to exploit a good thing. Unfortunately, LIPS became a victim of its own generosity and because the payout is so good it morphed into an attractive alternative to work.

It became obvious to the Directors of the Plan that something had to be done or a few less-scrupulous pilots would ruin it for everyone. They approached medical risk-assessment companies to get their guidance and a list of ‘self-reported disabilities’ was drafted. Is it sad that this had to be done? Absolutely. Is it a shame that a few bad apples had to spoil it for everyone else? Absolutely.

As an example, to use one of the self-reported disabilities on the list, ‘dizziness’…all a pilot has to say is, “I’m dizzy.” He doesn’t have to prove it…all he has to do is say it for 364 days, at which point Emirates will terminate him and give him a check for 3 years salary. Then he could come to LIPS and say, ‘pay me until I’m 65’. Let’s take it a step further…lets say this pilot is 25 years old. Is it fair to the rest of the members that he gets paid for the next 40 years just for saying two magical words, “I’m dizzy”? I’d think you’d agree that it’s not and that’s why the Plan had to change with the times.
Switchboard is offline  
Old 9th Mar 2018, 02:48
  #223 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
FRAUD

Just consulted with an Emirates Captain whose claim was declined after Harvey Watt said pre existing ....FRAUD...Joe Pack from Namibia ...Know Cliff Webster (Doctor Death) ?

Guys get the picture.

API can expect class actions from now on in.

Last edited by Thunderbirds54321; 9th Mar 2018 at 03:19.
Thunderbirds54321 is offline  
Old 9th Mar 2018, 02:54
  #224 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
Take it all back as far as switchboard is concerned....David from API you couldn’t even provide an e mail for Stephen Hare...I will on behalf and for the members leave you to face the law of the land thats ok ...with this link with a dubai mobile members and “payout” receivers can call with the hope someone picks up ....

https://www.aircrewprotection.org/contact-us

One of my best friends is a beneficiary and thats why I have cared to spend time nailing this lot down.





FACT meantime heres what a beneficiary who recently wrote to me and finally had his claim paid after six months of waiting for Harvey Watt & Co trying to find a reason to deny his claim.If a pilot who had his claim finally approved says this about API .

Im am happy to arrange my advocate meet any LIPS API pilot member in Dubai over the next two dasy to confirm this

(direct quote)

“of course a big thanks to you i am pretty sure you have contributed with your case and I am grateful.


But I also think that if the management is not changing that it is possible could collapse. That makes me also sad as it could be great system.But not the way it is run right now. A very strange setup. Definitely not what it should be. I don’t know where they are heading right now. Very concerning and I am aware of the danger that this won’t take long to go wrong.”

end of text quote




Im signing off here games over https://www.aircrewprotection.org/contact-us...current beneficiaries are invited to do what you need to do to prolong your “payouts”


best of luck and from here on in checkout your legal fees....so far they have been on the house

Last edited by Thunderbirds54321; 9th Mar 2018 at 05:58.
Thunderbirds54321 is offline  
Old 9th Mar 2018, 03:30
  #225 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
Originally Posted by skyvan View Post
Gardenshed,

I have a friend currently receiving the API payout, and a couple who did receive it, so I do know that it does work for those with a valid claim, I am also not saying that any other claim is or is not valid.

What I do object to is this incessant, aggressive posting when there is a case ready to go before the courts!

If it is going to the High Court, then he does not need public opinion on his side. If he has questions, let his legal team ask them. Once the answer is given in court, it becomes a matter of public record and then he can flood the internet as much as he likes, but until then, pushing innuendo and fluff at us just about every day is merely serving to make us hope for a resolution, either way, just to shut him up!

I am surprised his lawyers have not advised him to keep this off social media, once there is a court action the matter is sub-judice and anything he says now could jeopardise his case.

Either way, please, for now, just shut up and let the law take it's course. Nobody cares anymore, you have lost any support you might have had by not knowing when to be quiet!


Two indications you’ve just lost any argument sky van

telling your opponent to shut up

and if you are in a down market establishment ...punching someone (facing legal arrest )

your mates who you claim are already receiving “payouts” (installments paid by from the pockets of still fit working pilots) need to rise up (get off their ass and call Stephen Hare at Sovereign for any good that will do )or their free money will dry up.

The only way to stop someone using a credit card is to make them realize they can’t afford the interest and consequent repayments and cut the credit card in half.

Have any of you read “ Who moved my cheese”? It has little to do with the cheesy declarations of like "pilots helping pilots and we are few good men whose only ambition is to help pilots” kinky thoughts indeed.

On the subject of extreme dangerous sports Andy Bell used to fly around sand dunes with a propeller strapped to his hinterland....one of his mates had a propeller failure and fell 150 feet into the sand dunes and suffered significant leg injuries . dangerous indeed but no worries ...no pre existing condition .....extreme sports covered(benefits paid for by "pilots helping pilots")

I would be grateful for help from a friend or relative ...I remain suspicious of any “pilot" who goes around this world saying his to her only ambition is to “help" pilots.. pilot by nature can look after themselves ...so go away...give us a break ..help the poor, help the disabled.......pilots don’t need your creepy “help"


lets have this out in Dubai......I have documents to show the LIPS API members that will make their rare day off a ball

My advice to everyone is should you feel the need for insuring your flying license rule one says only do so with an insurance policy underwritten by Lloyd’s of London ... LIPS API are a very unfunny joke.
Better off treating yourself to a fine meal and a nice glass of wine that wasting your cash on BS

Last edited by Thunderbirds54321; 9th Mar 2018 at 05:40.
Thunderbirds54321 is offline  
Old 9th Mar 2018, 04:24
  #226 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
David with API your are called out after this post

Originally Posted by Switchboard View Post
Hello Payscale. Sorry it took so long to get back to you. I’m currently on a layover.

I don’t know when you joined, but when LIPS first started there were no restrictions, except pre-existing condition or suicide (obesity and smoking were added but then deleted as being too vague); but it was a different time at Emirates when pilots stayed until retirement. They were just being pilots and not everyone was an amateur lawyer looking to exploit a good thing. Unfortunately, LIPS became a victim of its own generosity and because the payout is so good it morphed into an attractive alternative to work.

It became obvious to the Directors of the Plan that something had to be done or a few less-scrupulous pilots would ruin it for everyone. They approached medical risk-assessment companies to get their guidance and a list of ‘self-reported disabilities’ was drafted. Is it sad that this had to be done? Absolutely. Is it a shame that a few bad apples had to spoil it for everyone else? Absolutely.

As an example, to use one of the self-reported disabilities on the list, ‘dizziness’…all a pilot has to say is, “I’m dizzy.” He doesn’t have to prove it…all he has to do is say it for 364 days, at which point Emirates will terminate him and give him a check for 3 years salary. Then he could come to LIPS and say, ‘pay me until I’m 65’. Let’s take it a step further…lets say this pilot is 25 years old. Is it fair to the rest of the members that he gets paid for the next 40 years just for saying two magical words, “I’m dizzy”? I’d think you’d agree that it’s not and that’s why the Plan had to change with the times.


Bad apples find themselves David and Co (your Captains salary for some reason isn’t cutting the mustard or whatever...) please stop posting API glupe and post Stephen Hares mobile and e mail ( no guarantees he will answer but the GFSC and ombudsman may find other wise )

Actually I will provide members with it here Hares contact details... ....stand by

Last edited by Thunderbirds54321; 9th Mar 2018 at 04:52.
Thunderbirds54321 is offline  
Old 9th Mar 2018, 06:23
  #227 (permalink)  
 
Join Date: Apr 2001
Location: overthere
Posts: 3,005
Likes: 0
Received 0 Likes on 0 Posts
So who should pay for the lawyers if not the fund? Shouldn't you have the right to argue your case legally and they have the right to legally respond?
donpizmeov is online now  
Old 9th Mar 2018, 08:38
  #228 (permalink)  
 
Join Date: Sep 2007
Location: UAE
Posts: 203
Likes: 0
Received 0 Likes on 0 Posts
Hi Switchboard,

My point is that most insurance companies deem things like Skiing, Scuba diving etc as extreme sports and hence require separate cover.
API should not cover things like this as it is your personal choice, when an ever increasing list which you say comes from medical experts, declines to cover diseases which aren't.
As you say you ski, that is your choice and your right, but why should my contributions go towards you if you loose your medical if God forbid something was to happen to you doing that, when coverage was declined to friend of mine who lost his medical through no fault of his own.
gardenshed is offline  
Old 9th Mar 2018, 08:49
  #229 (permalink)  
 
Join Date: Jan 2015
Location: Mars
Posts: 72
Likes: 0
Received 0 Likes on 0 Posts
Tbird, I've read this whole thread from start to finish a couple of times now...

Correct me if I'm wrong - you (posting as footballfanppl) posted because your claim was extensively delayed. That claim later was rejected due to 'pre-existing conditions'. You indicate you have extensive, diverse or at the very least multiple medical opinions to the contrary. You've discovered there's no appeal process and you feel, to be blunt, screwed.

You're making some good points. The members should be concerned about there being no appeal process. The members should be concerned if a provider of professional services to the scheme isn't a member of their service's standard 'association' when the vast majority of other providers are.

On the other hand you are making some absolutely ridiculous howlers.

You 'asked a Senior Claims Consultant at Harvey Watt & Co as to whether they are a regulated company' and claim to have received the reply 'no we are not bound by ERISA' and based on that titled your post "PROOF LIPS API Appointed US based Assessor Harvey Watt & Co is Non Regulated".

ERISA is an American law. Why on earth would you even begin to expect it to apply to a scheme marketed to pilots based in the UAE? Also - why would somebody from a medical assessment firm ever think to say such a thing? Their employer (the scheme) would be the party to confirm or deny ERISA applicability.

I checked the Harvey Watt website and found they were based in Georgia. They claim to be a Licensed Third Party Administrator, I checked the Georgia state registry and was quite unsurprised to find them listed accordingly with 'active' status, license # 94153. Don't just take my word for it, check yourself. The website is www.oci.ga.gov

You can find them in 'insurers->search' as a Third Party Administrator and also in 'Agencies->Agency Search' as an agency.


As to their medical staff, I've had no correspondence with them so don't have any particular doctors to look up. I found a couple of names after trawling through some industry circulars and inserted them into the AMA's 'doctor finder' website, both came up as Aeromedical specialists.

You also repeated several times "Harvey Watt & Co receive commissions /renumeration from LIPS/API for case assessments with the amount Harvey Wayy & Co receive being dependent on percentage saved denying a pilots claim." It's a ridiculous thing to even suggest, isn't it? No reputable 'independent' third party firm would accept those terms. Even if you hypothecate up a situation where a 'reputable' firm took a contract on that basis, their doctors - much like pilots - are licensed personally and liable for malpractice personally. It's ridiculous.

Then you go on again to make a reasonable point - "Carrying on a regulated activity in the UK without authorisation or the benefit of an applicable exemption, such as effecting and carrying out contracts of insurance, is a criminal offence." That's a good point to follow up but you never did, you just ranted yourself down a hole claiming a 'conflict of interest' between CAMA and HW - if HW sponsor CAMA and a doctor who works for HW is a CAMA member there's only a conflict of interest if HW will gain or lose as a result of the decision. And if that were the case then - as explained above - merely being employed by HW would create a conflict of interest, forget CAMA.

"If Harvey Watt is making decisions, then surely legal liability should be with them, and the fund not be using pilot members' money to defend against legal action."

Giving a medical opinion isn't making a decision. If the trust has clear rules then they will be given a report template which maps to the trust rules. If trust rules are 'we pay out for all conditions barring angina and epilepsy' then their report template would just be two questions: 1. Is the debilitating illness angina? 2. Is the debilitating illness epilepsy? This is the only professional way to do it: the medical team shouldn't even know how the answers equate to a claim's success or failure, and of course all the files should be anonymised.

A pre-existing claim decision complicates matters - one doctor may see a file which says 'consistent right frontal headaches for 3 months in 2004, ten years later right frontal brain cancer' and say 'pre-existing' and another may look at the same file and say 'probably pre-existing but I can't prove it'.

You should focus your energy along these lines.

Here are some good questions:
  • Are medical files anonymised prior to assessment?
  • To the greatest extent possible is sex, age, religious or racially identifying information removed from the medical files before assessment?
  • If the formatting or wording of some documents clearly indicates their origin in a way that may cause bias (imagine Syrian Air Force medical records) are they retyped or obfuscated?
  • Is the medical team given a strict yes/no reporting format which matches only the trust rules?
  • Does the reporting format disguise or randomise, where possible, questions and desired answers to avoid 'pattern bias' or 'result bias' (a person may be subconsciously inclined or disinclined to either tick yes 20 times in a row OR to tick no after ticking yes 20 times.)
  • If a freeform report is produced is it possible that the reviewer would include biasing information unrelated to the larger claim. For example, a pilot may have a perfectly valid claim - something entirely physical such as a whole-arm amputation - but discover during their hospital visit they're HIV+. A fully comprehensive report in such a case produces bias risk.
  • If there is a yes/no check box for a judgement based decision such as 'is this a pre-existing condition' are there clear written instructions readily to hand which specify the applicable standard such as 'beyond any reasonable doubt' or 'beyond mere balance of probability'?
  • If a freeform report is produced containing the words 'in my opinion this is a pre-existing condition' then likewise - have they been instructed to only write that if they are convinced 'beyond a reasonable doubt' or can they write that if they are convinced 'beyond the balance of probability'?
  • Who decided which standard is to be followed? for what reason?
  • If a freeform report says 'it is likely that the condition is pre-existing' is the trust's decision going to to be consistently approve, consistently deny or a dice roll?
  • Is a review risk mitigation process followed - such as having all evaluations performed separately by two randomly selected assessors followed by secret ballot?
  • In the event of a tie requiring another reviewer, is the assignment of the other reviewer guaranteed to be entirely random and un-influenceable by the prior reviewers?
  • Is a more senior reviewer selected in the event of a tie?
  • If a reviewer's decision is overruled by a senior reviewer (once, twice, thrice) are their historical decisions audited?

Ask the questions that matter. The medical evaluation is your problem, so get stuck into it. Be systematic.

Don't ask ridiculous questions like 'Is it true that Aircrew Protection International are about to attempt to defend a major lawsuit in the Channel Islands using the pilot fund to finance same?'

  • If they have no reason to think the trust rules have not been followed they are obliged to defend the trust assets, and remember, the loser pays everyone's legal fees.
  • There will (should!) be zero provision in the trust rules for them to be able to pay you off or give you some shut-up money. If the rules allow this, uhoh.
I'm guessing some members want you to win and some want you to lose. I'm pretty damn sure no members want you to get paid off for being obnoxious.

Last edited by Lascaille; 9th Mar 2018 at 12:37.
Lascaille is offline  
Old 9th Mar 2018, 13:18
  #230 (permalink)  
 
Join Date: Mar 2015
Location: Dubai
Age: 35
Posts: 23
Likes: 0
Received 0 Likes on 0 Posts
@Lascaille

That's one of the most well-written posts ever on PPRuNe.
MusingMonk is offline  
Old 20th Apr 2018, 00:20
  #231 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
a visit from a claimant denied who through a recommended and trusted colleague required help to counter a claim denial based on a harvey watt pre existing conditional denial ......after consultation with expression of intention to sue within two weeks claim approved.....then semi endorsement on scam
Thunderbirds54321 is offline  
Old 20th Apr 2018, 00:28
  #232 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
Originally Posted by Thunderbirds54321 View Post
a visit from a claimant denied who through a recommended and trusted colleague required help to counter a claim denial based on a harvey watt pre existing conditional denial ......after consultation with expression of intention to sue within two weeks claim approved.....then semi endorsement on scam


SO quick turnaround or cost extreme to the members....lets see
Thunderbirds54321 is offline  
Old 10th May 2018, 15:11
  #233 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
And “ ain’t “ is not a word FYI

Originally Posted by fliion View Post
I believe what Don means is - if you get sued and before the court rules, does that automatically mean that the claimant / claim is valid?

Because in that case, just file and forget about the ruling - because ‘hey, I filed, I’m right.’

Claim ain’t a judgment gents.

ain't. 1706, originally a contraction of am not, and in proper use with that sense until it began to be used as a generic contraction for are not, is not, etc., in early 19c. Cockney dialect of London; popularized by representations of this in Dickens, etc., which led to the word being banished from correct English.

Thunderbirds54321 is offline  
Old 10th May 2018, 18:36
  #234 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
AIRCREW PROTECTION TRUST MEMBER TERMS & CONDITIONS
1. DEFINITIONS:

“Trust” means the Aircrew Protection Trust.
“Member” means such individuals who pay contributions into the Trust.
“API Rules” means the current rules of the Trust applicable on Member.
“Contributions” means the Monthly and/or Yearly Contributions payable by Members into the Trust Account.
“Yearly Contributions” means the sum of AED 4,939 per year payable by Members who sign up for payment of Contributions on yearly basis.
“Monthly Contributions” means the sum of AED 4495 per month, payable by Members who sign up for payment on monthly basis.
“Trust Account” means the account controlled by the Trust into which the Member pay their respective Contributions.

2. API RULES

These Terms & Conditions are complementary to, and shall be read in conjunction with, the API Rules. In case of any conflict between the API Rules and the Terms & Conditions, terms of the API Rules shall be deemed to prevail. By accepting these Terms & Conditions, Members accept the API Rules in entirety in addition to the following terms. API Rules can be found at Aircrew Protection International | Dashboard

3. MEMBERSHIP & CONTRIBUTIONS
  • Members may become members of the Trust by registering with the Trust and agreeing to pay either into the Trust Account :
    • Monthly Contributions
    • Yearly Contributions.
  • Members who sign up for payment on monthly basis are obliged to pay the Monthly Contributions into the Trust Account. Any Monthly Contribution received in a particular month shall be accounted for a Monthly Contribution towards that particular month. For example, a Monthly Contribution received into the Trust Account on 25th day of July will count as a Monthly Contribution pertaining to the month of July.
  • Members who sign up for payment on yearly basis are obliged to the Yearly Contribution into the Trust Account. Payment of the Yearly Membership allows a Member to enjoy membership of the Trust for one year following the date of payment of such Yearly Contribution and includes one free month’s eligibility.
  • Eligibility of Members shall be determined in accordance with the API Rules.
  • In the event no payment of Contribution is received in respect a month when such Contribution is due, the Member is deemed to be in default of payment, and issued a thirty (30) days’ notice to effect payment of pendin g Contributions. In the event the Member’s default continues beyond expiry of the notice period, the defaulting Member’s membership from the Trust shall be automatically terminated, and the Member is notified by the Trust to such effect.
  • In the event a Member inadvertently pays twice, or more, in the same month then, upon notification to the Trust, the Member shall be given the option of either:
    • a refund to his bank account to be sent on the last day of the month following the Member supplying his/her banking details.
    • carrying forward the excessive payment as credit (“Credit”)
    In the event a Member resigns as a pilot from Emirates Airlines or the Trust and, upon notification to the Trust, such Member shall be immediately instructed by the Trust to stop paying his/her Contributions. In the event such Member does not stop paying his/her Contributions, such payments shall be deemed to be overpayments, and shall be refunded to his/her bank account for as long as the Trust continue s to receive Contributions from such Member.
  • In the event a Contribution is paid by a Member, but not received into the Trust Account, the Trust shall not be responsible for the same, and such Contribution shall be deemed to have not been received by the Trust. The Member shall be required to repay the Contribution, and in the event the Trust receives the earlier Contribution at a later point in time, such Contribution shall be dealt with in accordance with clause above.
  • If, after a Member receives his Benefit(s) from the Trust , a determination is made that he/she was not eligible to receive such Benefit(s) , an amount equal to the entirety of a Member’s Contribution to the Trust will be refunded to the Member. This refund will constitute termination of the Member from the Trust and the Member will receive no further Benefit (s) or consideration therefrom.
  • Members will pay 3.95% of the transaction amount and $0.65 per transaction.
4. BENEFITS

Upon membership in accordance with the clause above, and regular payment of Contributions, and subject to the API Rules, Members are entitled to the following benefits (“Benefits”)
  • Payment of AED 25,000 per month, which is subject to an increase at the rate of 3% per annum, and capped at an amount of AED 35,000, payable until the Member’s 65th birthday in the event the Member loses his/her GCAA Class 1 Medical Certificate, and is terminated by the Emirates Airlines as a consequence thereof (please refer to detailed mechanism set forth in API Rules);
  • Life insurance in the sum of $100,000, extendable to $500,000, in accordance with the terms and conditions of a third - party insurer.
  • Life insurance in the sum of $50,000 life insurance Member’s spouse, fiancé or life partner, in accordance with the terms and conditions of a third - party insurer
  • Legal insurance in the sum of $50,000 in the event the Member is involved in an incident while acting as flight crew.
5. TERMINATION & EFFECTS OF TERMINATION
  • Termination of membership shall be in accordance with the API Rules.
  • In the event a Member withdraws his/her membership from the Trust, but continues to serve as a pilot with Emirates Airlines then, upon notification to the Trust, any such Member shall be immediately instructed by the Trust to stop paying his/her Contributions. In the event such Member does not stop paying his/her Contributions, such payments shall be deemed to be overpayments, and shall be refunded to the Member’s bank account to be sent on the last day of the month following the Member supplying his/her banking details.
  • In the event it is found that a Member is not eligible to receive the Benefits stipulated above, after his termination by the Emirates Airlines:
    • any Credit held by the Trust in his favor shall be immediately refunded into the Member’s bank account to be sent on the last day of the month following the Member supplying his/her banking details; and
    • Any and all Contributions paid by the Member via credit card since the commencement of his membership with the Trust shall be refunded to his/her bank account to be sent on the last day of the month following the Member supplying his/her banking details. Meanwhile, such portion of the Member’s Contributions as may have been paid by him/her via means other than credit card, shall be refunded to the Member by means other than credit card.
  • In the event a Member resigns as a pilot from Emirates Airlines or the Trust, such Member shall be immediately instructed by the Trust to stop paying his/her Contributions. In the event such Member does not stop paying his/her Contributions, such payments shall be eemed to be overpayments, and shall be refunded to his/her bank account to be sent on the last day of the month following the Member supplying his/her banking details for as long as the Trust continues to receive Contributions from such Member.
6. INDEMNITY

The Members agree to indemnify, defend and hold harmless the Trust, its directors, trustees, officers, employees, consultants, agents, and affiliates, from any and all third party claims, liability, damages and/or costs (including, but not limited to, legal fees) arising from their payment using this online platform, and/or from their breach of the se Terms & Conditions or the API Rules.7. PRIVACY

The Members agree to indemnify, defend and hold harmless the Trust, its directors, trustees, officers, employees, consultants, agents, and affiliates, from any and all third party claims, liability, damages and/or costs (including, but not limited to, legal fees) arising from their payment using this online platform, and/or from their breach of the se Terms & Conditions or the API Rules.8. INTELLECTUAL PROPERTY

The Members agree and acknowledge that the Trust is the sole legal and beneficial owner of all trademarks, patents, copyrights, logos, names, symbols, fonts, images and other intellectual property of, or connected to the brand “Aircrew Protection International ” , whether such intellectual property is displayed by the Trust on its website, marketing materials, social media, forms, advertisements, publications, or any other form of media.

9.VARIATION

The Trust shall have the right in its absolute discretion at any time and without notice to amend, remove or vary the contents of these Terms & Conditions and/or the API Rules.

10. SEVERANCE

If any part of the Terms & Conditions is unenforceable, the enforceability of any other part of these Terms & Conditions will not be affected, and all other clauses shall remain in full force and effect. So far as possible where any clause/sub - clause or part of a clause/sub - clause can be severed to render the remaining part valid, the clause shall be interpreted accordingly.11. WAIVER

If a Member breaches any part of these Terms & Conditions, and the Trust takes no action, such inaction will, by no means amount to a waiver in respect of any of the Trust’s rights and remedies.12. ENTIRE AGREEMENT

The above Terms & Conditions, along with the API Rules, constitute the entire agreement between the Trust and Members .13. JURISDICTION

All disputes arising in any way out of or affecting this agreement shall be subject to the non - exclusive jurisdiction of the Guernsey courts to which the parties hereto agree to submit.

Last edited by Thunderbirds54321; 10th May 2018 at 19:24.
Thunderbirds54321 is offline  
Old 10th May 2018, 18:39
  #235 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
1. PURPOSE OF THE APPEAL PROCESS.

1.1. API hopes that any disputes, if they arise, can be resolved with as little inconvenience and delay as possible. To that end, the API Plan Rules provide a procedure whereby a Member may appeal an Initial Benefit Determination.
  1. THE INITIAL BENEFIT DETERMINATION
    1. 2.1. The Initial Benefit Determination is made entirely at the discretion of the Trustee and is based upon the guidance contained in the recommendation of the Trustee’s Medical Advisor (the“Recommendation”) and the API Plan Rules, and shall be consistent with the applicable laws of the Island of Guernsey (“Guernsey Law”) and the regulations set forth by the Guernsey Financial Services Commission (the “GFSC Regulation(s)”).
    2. 2.2. When deliberating how to implement the Recommendation, the Trustee give full consideration to any conflicts between the Recommendation and Guernsey Law, the GFSC Regulations and the API Plan Rules, all of which govern how the Trustee administers the Plan. In the event of a conflict between the Recommendation and any Guernsey Law, GFSC Regulation or API Plan Rule, the relevant Guernsey Law, GFSC Regulation or API Plan Rule shall govern.
    3. 2.3. In carrying out its respective responsibilities, the Trustee shall have the sole discretion to interpret the API Plan Rules and to determine the eligibility for an entitlement to any benefits under the API Plan.
    4. 2.4. The Trustee has sole discretion to interpret the API Plan Rules in deciding whether to allow any appeal, determining the outcome of any appeal, and make all benefit determinations.
    5. 2.5. Any interpretation or determination made pursuant to the discretionary authority of the Trustee shall be given full force and effect except as set forth to the contrary herein.
    6. 2.6. For the avoidance of doubt benefits under the API Plan shall only be payable if the Trustee, in its sole discretion, decides that the Member is entitled to them.
  2. SUBMISSION OF APPEAL.
    1. 3.1. Timeline: If a Member wishes to dispute an Initial Benefit Determination, he or she must initiate a request for appeal within 90-calendar days after receiving their Notice of Entitlement or notice that the claim has been denied. All requests should be submitted to API the Trustee using the following email address: [email protected]. Any request received by API after this 90-calendar day filing period will be denied.
    2. 3.2. Evidence:
      1. 3.2.1. The revocation of a Class I Medical Certificate by the GCAA (or other respective regulatory body) is made by an autonomous regulator and is based upon the Medical Certificate Revocation Documents.
      2. 3.2.2. It is outside the control and authority of API and the Trustee.
      3. 3.2.3. The Recommendation, which the Trustee considers in making its Initial Benefit Determination, is also made on the basis of the Medical Certificate Revocation Documents and any reports or correspondence furnished to the Trustee’s MedicalAdvisor by the review board of the GCCA (or respective aviation regulatory body) pursuant to their review (where applicable).
  1. 3.2.4. In support of any appeal, a Member may submit additional evidence, provided that any evidence presented by the Member must be received within the 90 calendar day filing period referenced in section 3.1 above and must pre-date the Revocation Date.
  2. 3.2.5. Any evidence which post-dates the Revocation Date would not have been considered by the GCAA (or other respective regulatory body) and, therefore, cannot beconsidered by the Trustee’s Medical Advisor or the Trustee.
  1. THE APPEAL PROCESS – STAGE 1 – TRUSTEE RE-EVALUATION.
    1. 4.1. Where a Member wishes to appeal an Initial Benefit Determination, he or she may do so by requesting the Trustee to exercise its discretion to conduct a re-evaluation of the Member’sclaim in the first instance.
    2. 4.2. The Trustee will only conduct a re-evaluation based upon the provision by the Member of new evidence (as described in 3.2 above), and only if the Trustee, in its sole discretion, decides on the balance of the evidence provided it is necessary to do so.
    3. 4.3. In conducting its reassessment, The Trustee may seek guidance or clarification from theTrustee’s Medical Adviser, the Consultants to the API Trust, the Plan administrators and its consultants, the accountants contracted to the Trust and / or the attorneys contracted by the API Trust (the Appeal Tribunal).
    4. 4.4. The Appeal Tribunal shall conduct a review of the Initial Benefit Determination, and such review shall be based on evidence the Member provides as noted in Section 3.2; the evidence may or may not be of a medical nature and is wholly at the discretion of the Member to provide.
    5. 4.5. During the Review:
      1. 4.5.1. No deference will be given to the Initial Benefit Determination; and
      2. 4.5.2. The Appeal Tribunal shall have the discretion to interpret the Plan.
    6. 4.6. When the review is complete, the Trustee shall, in its sole discretion, make a decision regarding the outcome of the review, will notify the Member of its decision and may, if so required, issue a revised Notice of Entitlement.
    7. 4.7. If the appeal is denied, in whole or in part, the Member will be informed of the specific reason(s) for the denial and a reference to the specific API Plan Rule or point of law or decision point on which the decision is based.
    8. 4.8. If the Member does not agree with the outcome of the review, the Member may request a review under Stage 2 of this process. In such instances, the Trustee shall have the sole discretion to allow or deny such appeal.
  2. THE APPEAL PROCESS – STAGE 2 – AEROMEDICAL ADVISORS ASSESSMENT.
    1. 5.1. The Member shall, at his or her own cost, choose an Aeromedical Advisor and notify the

      Trustee of the details of the chosen Aeromedical Advisor in writing.
    2. 5.2. The Trustee shall choose an Aeromedical Advisor and notify the Member of the details of the chosen Aeromedical Advisor in writing.
    3. 5.3. Both Aeromedical Advisors shall form a panel and review:
5.3.1. the Member’s records;
  1. 5.3.2. Medical Certificate Revocation Documents;
  2. 5.3.3. the findings of the medical panel of the GCAA (or other respective regulatory body) (as applicable);
  3. 5.3.4. the API Plan Rules; and
  4. 5.3.5. if necessary, examine the Member.
The Aeromedical Advisors may consult with licensed, board-certified medical specialists trained in the medical field in question if they encounter queries or specific medical or technical terms beyond the scope of their usual expertise.
  1. 5.4. Each Aeromedical Adviser shall draft a report of their assessments, following which they will arrange a mutually convenient time to discuss their respective reports and produce a joint report containing their joint and/or respective recommendations.
  2. 5.5. If the two Aeromedical Advisors come to an agreement:
    1. 5.5.1. they will send the joint report to the Member and to the Trustee;
    2. 5.5.2. the Trustee will consider the joint report and use its discretion to decide the outcome of the appeal;
    3. 5.5.3. the Trustee will notify the Member of its decision; and
    4. 5.5.4. if so required, issue an amended or new Notice of Entitlement.
6. THE APPEAL PROCESS – STAGE 3 – AEROMEDICAL ARBITRATOR ASSESMENT
  1. 6.1. If the two Aeromedical Advisors are unable to agree, they will mutually agree upon a suitably qualified Aeromedical Arbitrator.
  2. 6.2. The Member and the Trustee shall execute any agreements as may be necessary to implement the arbitration process.
  3. 6.3. The Aeromedical Arbitrator will examine:
    1. 6.3.1. the joint and individual reports of the Aeromedical Advisors;
    2. 6.3.2. all Medical Certificate Revocation Documents;
    3. 6.3.3. the findings of the medical panel of the GCAA (or other respective regulatory body) (as applicable);
    4. 6.3.4. the API Plan Rules;
    5. 6.3.5. any other relevant information pertinent to the claim, including the reports submitted by the two Aeromedical Advisors; and
    6. 6.3.6. if necessary, shall examine the Member.
  4. 6.4. The Aeromedical Arbitrator may also, if necessary, meet with the two Aeromedical Advisors ata mutually acceptable time and place to formulate their final opinion regarding the Member’sdisability and compliance with the benefit conditions and eligibility under the API Plan
Rules. This meeting may be held by means of a remote electronic communication system, including video or telephone conferencing technology or the Internet, or any combination.
  1. 6.5. The Aeromedical Arbitrator may also consult with licensed, board-certified medical specialists trained in the medical field in question if they encounter queries or specific medical or technical terms beyond the scope of their usual expertise.
  2. 6.6. The Aeromedical Arbitrator may also consult with the Trustee if they require clarification regarding the wording of the API Plan Rules.
  3. 6.7. Following a thorough assessment, the Aeromedical Arbitrator shall submit the final opinion in writing to the Member and to the Trustee.
  4. 6.8. The Member and the Trustee shall be bound by and shall implement such final opinion of the Aeromedical Arbitrator, and if required the Trustee shall issue a revised Notice of Entitlement.
  5. 6.9. Aeromedical Arbitrator Compensation: When the Aeromedical Advisors select an Aeromedical Arbitrator, the Aeromedical Arbitrator will submit an estimate of the fees of such evaluation to the Member and to the Trustee prior to any information being disclosed to him / her. Thereafter:
    1. 6.9.1. API and the Member will each post with an escrow agent nominated by the Trustee,an amount equal to half (1/2) of the Aeromedical Arbitrator’s fee.
    2. 6.9.2. If the final opinion of the Aeromedical Arbitrator is in favor of the Member, the Trustee shall pay the total cost of both Aeromedical Advisers and the Aeromedical Arbitrator’s fee and the Member’s portion of the funds in escrow will be released back to theMember.
    3. 6.9.3. If the final opinion is in favor of the Trustee, the Trustee shall pay half (1/2) of the cost of the Aeromedical Arbitrator. The Member will pay half (1/2) the cost of the Aeromedical Arbitrator; the total cost of the Aeromedical Arbitrator will be paid from the funds placed in escrow. The Trustee or the Member may request additional time to post funds in escrow but in no event, such funds shall be posted no later than 30 days from the date notified and no final opinion will be given by the Aeromedical Arbitrator until such funds have been placed in escrow.
7. THE RULES OF THE PLAN AND MEMBER ACCEPTANCE.
  1. 7.1. The current version of the API Plan Rules posted on the API website (as may be amended from time to time) shall be the valid controlling version. By virtue of the Member applying to become a member of API, the Member accepts and acknowledges that the API Plan Rules shall govern any decision regarding benefits.
  2. 7.2. This appeal process is a part of the API Rules.
  3. 7.3. In accepting the API Plan Rules, the Member agrees that the decision of the Trustee (or the Aeromedical Advisors or Aeromedical Arbitrator (where applicable)) reached as a result of the appeal process detailed herein with regard to his/her claim shall be final and binding, and the Member shall have no right to contest such decision(s) except as set forth below. The Member further acknowledges and agrees that the appeal process described herein is the sole and exclusive recourse for any and all controversies or claims arising out of or in connection with the API Plan and the Member expressly waives his / her right to file court actions disputing the decision of the appeal process except to enforce the appeal process and/or its legally binding decision except as set forth below.
8. APPEALING THE DECISION OF THE TRUSTEE FOLLOWING THE APPEAL PROCESS ALLOWED IN CERTAIN CIRCUMSTANCES.

8.1. In the event the Member is not satisfied with the decision of the Trustee, he / she may contest the decision before a competent court of Guernsey, based solely on the following grounds:
  1. 8.1.1. The Aeromedical Arbitrator failed to address the relevant Medical Certificate Revocation Documents and / or other relevant information pertinent to the claim, including the reports submitted by the two Aeromedical Advisors in reaching their decision. For clarity, in addressing the relevant Medical Certificate Revocation Documents and / or any other relevant information pertinent to the claim, the Aeromedical Arbitrator fulfills the obligation by considering the same regardless of the final opinion forwarded to the Trustee; or
  2. 8.1.2. There was a misapplication of relevant law or procedure by the Trustee and it can be demonstrated that the decision of the Trustee was arbitrary, capricious or failed to address the final opinion of the Aeromedical Arbitrator.
9. DEFINITIONS:
Aeromedical Advisor means a physician who is a licensed specialist, certified in aviation or

aerospace medicine. The Member and API may each select an Aeromedical Advisor.

Aeromedical Arbitrator means an independent physician who is a licensed specialist, certified in aviation or aerospace medicine and suitably qualified in aeronautical and medical arbitration, whose selection is mutually agreed upon by the Aeromedical Advisors.

Air Carrier shall have the meaning prescribed to it in the API Plan Rules.

API Plan Rules means the current version of the rules of the API Plan posted on the API website, asmay be amended from time to time (each individual provision a “Plan Rule”). For the avoidance of doubt the current version of the API Plan Rules on the date that a benefit claim is filed shall be the controlling version for the claim.

Initial Benefit Determination means the decision of the Trustee contained in a Notice of Entitlement to deny benefits to any one member or to award any Member a reduced benefit entitlement. SuchInitial Benefit Determination is based upon the recommendation of the Trustee’s Medical Advisor, the API Plan Rules, and shall be consistent with the applicable laws of the Island of Guernsey and the regulations set forth by the Guernsey Financial Services Commission.

Medical Certificate Revocation Documents means the medical documents and interviews submitted by the appropriate Air Carrier and medical service provider(s) contracted by the GCAA
or other respective regulatory body.

Notice of Entitlement shall have the meaning prescribed to it in the API Plan Rules.
Revocation Date means the date of the revocation of the Class I Medical Certificate by the GCAA or

other respective regulatory body.

Trustee means Sovereign Trust (Guernsey) Limited as Trustee of the Aircrew Protection International Trust.

Trustee’s Medical Advisor means the medical service provider(s) whose recommendation the Trustee considers when making the Initial Benefit Determination.

Last edited by Thunderbirds54321; 13th May 2018 at 16:14.
Thunderbirds54321 is offline  
Old 14th May 2018, 16:42
  #236 (permalink)  
 
Join Date: Nov 2017
Location: Casablanca
Posts: 45
Likes: 0
Received 0 Likes on 0 Posts
Lascalle: your view requested on API Appeal Procedure

Thank you for your detailed response.

The night before your post below a meeting was hosted for an aggrieved declined claimant (name withheld for now for confidentiality) . This Captain concerned met to obtain information to initiate a lawsuit. He stated he had been wrongly declined for benefit based on a claim of pre existing condition cited by Harvey Watt & Co and was provided with details of legal counsel to support pursuance of his case. The individual concerned stated that in response to his contestation of denial he had received a call from a CPT JP from API who on being advised of intention to sue stated he would be in touch. Two weeks after this meeting the individual concerned was advised the decision had been reversed and his claim was approved overruling Harvey Watt & Co “recommendation".



Originally Posted by Lascaille View Post
Tbird, I've read this whole thread from start to finish a couple of times now...

Correct me if I'm wrong - you (posting as footballfanppl) posted because your claim was extensively delayed. That claim later was rejected due to 'pre-existing conditions'. You indicate you have extensive, diverse or at the very least multiple medical opinions to the contrary. You've discovered there's no appeal process and you feel, to be blunt, screwed.

You're making some good points. The members should be concerned about there being no appeal process. The members should be concerned if a provider of professional services to the scheme isn't a member of their service's standard 'association' when the vast majority of other providers are.

On the other hand you are making some absolutely ridiculous howlers.

You 'asked a Senior Claims Consultant at Harvey Watt & Co as to whether they are a regulated company' and claim to have received the reply 'no we are not bound by ERISA' and based on that titled your post "PROOF LIPS API Appointed US based Assessor Harvey Watt & Co is Non Regulated".

ERISA is an American law. Why on earth would you even begin to expect it to apply to a scheme marketed to pilots based in the UAE? Also - why would somebody from a medical assessment firm ever think to say such a thing? Their employer (the scheme) would be the party to confirm or deny ERISA applicability.

I checked the Harvey Watt website and found they were based in Georgia. They claim to be a Licensed Third Party Administrator, I checked the Georgia state registry and was quite unsurprised to find them listed accordingly with 'active' status, license # 94153. Don't just take my word for it, check yourself. The website is www.oci.ga.gov

You can find them in 'insurers->search' as a Third Party Administrator and also in 'Agencies->Agency Search' as an agency.


As to their medical staff, I've had no correspondence with them so don't have any particular doctors to look up. I found a couple of names after trawling through some industry circulars and inserted them into the AMA's 'doctor finder' website, both came up as Aeromedical specialists.

You also repeated several times "Harvey Watt & Co receive commissions /renumeration from LIPS/API for case assessments with the amount Harvey Wayy & Co receive being dependent on percentage saved denying a pilots claim." It's a ridiculous thing to even suggest, isn't it? No reputable 'independent' third party firm would accept those terms. Even if you hypothecate up a situation where a 'reputable' firm took a contract on that basis, their doctors - much like pilots - are licensed personally and liable for malpractice personally. It's ridiculous.

Then you go on again to make a reasonable point - "Carrying on a regulated activity in the UK without authorisation or the benefit of an applicable exemption, such as effecting and carrying out contracts of insurance, is a criminal offence." That's a good point to follow up but you never did, you just ranted yourself down a hole claiming a 'conflict of interest' between CAMA and HW - if HW sponsor CAMA and a doctor who works for HW is a CAMA member there's only a conflict of interest if HW will gain or lose as a result of the decision. And if that were the case then - as explained above - merely being employed by HW would create a conflict of interest, forget CAMA.

"If Harvey Watt is making decisions, then surely legal liability should be with them, and the fund not be using pilot members' money to defend against legal action."

Giving a medical opinion isn't making a decision. If the trust has clear rules then they will be given a report template which maps to the trust rules. If trust rules are 'we pay out for all conditions barring angina and epilepsy' then their report template would just be two questions: 1. Is the debilitating illness angina? 2. Is the debilitating illness epilepsy? This is the only professional way to do it: the medical team shouldn't even know how the answers equate to a claim's success or failure, and of course all the files should be anonymised.

A pre-existing claim decision complicates matters - one doctor may see a file which says 'consistent right frontal headaches for 3 months in 2004, ten years later right frontal brain cancer' and say 'pre-existing' and another may look at the same file and say 'probably pre-existing but I can't prove it'.

You should focus your energy along these lines.

Here are some good questions:
  • Are medical files anonymised prior to assessment?
  • To the greatest extent possible is sex, age, religious or racially identifying information removed from the medical files before assessment?
  • If the formatting or wording of some documents clearly indicates their origin in a way that may cause bias (imagine Syrian Air Force medical records) are they retyped or obfuscated?
  • Is the medical team given a strict yes/no reporting format which matches only the trust rules?
  • Does the reporting format disguise or randomise, where possible, questions and desired answers to avoid 'pattern bias' or 'result bias' (a person may be subconsciously inclined or disinclined to either tick yes 20 times in a row OR to tick no after ticking yes 20 times.)
  • If a freeform report is produced is it possible that the reviewer would include biasing information unrelated to the larger claim. For example, a pilot may have a perfectly valid claim - something entirely physical such as a whole-arm amputation - but discover during their hospital visit they're HIV+. A fully comprehensive report in such a case produces bias risk.
  • If there is a yes/no check box for a judgement based decision such as 'is this a pre-existing condition' are there clear written instructions readily to hand which specify the applicable standard such as 'beyond any reasonable doubt' or 'beyond mere balance of probability'?
  • If a freeform report is produced containing the words 'in my opinion this is a pre-existing condition' then likewise - have they been instructed to only write that if they are convinced 'beyond a reasonable doubt' or can they write that if they are convinced 'beyond the balance of probability'?
  • Who decided which standard is to be followed? for what reason?
  • If a freeform report says 'it is likely that the condition is pre-existing' is the trust's decision going to to be consistently approve, consistently deny or a dice roll?
  • Is a review risk mitigation process followed - such as having all evaluations performed separately by two randomly selected assessors followed by secret ballot?
  • In the event of a tie requiring another reviewer, is the assignment of the other reviewer guaranteed to be entirely random and un-influenceable by the prior reviewers?
  • Is a more senior reviewer selected in the event of a tie?
  • If a reviewer's decision is overruled by a senior reviewer (once, twice, thrice) are their historical decisions audited?
Ask the questions that matter. The medical evaluation is your problem, so get stuck into it. Be systematic.

Don't ask ridiculous questions like 'Is it true that Aircrew Protection International are about to attempt to defend a major lawsuit in the Channel Islands using the pilot fund to finance same?'
  • If they have no reason to think the trust rules have not been followed they are obliged to defend the trust assets, and remember, the loser pays everyone's legal fees.
  • There will (should!) be zero provision in the trust rules for them to be able to pay you off or give you some shut-up money. If the rules allow this, uhoh.
I'm guessing some members want you to win and some want you to lose. I'm pretty damn sure no members want you to get paid off for being obnoxious.

1. PURPOSE OF THE APPEAL PROCESS.

1.1. API hopes that any disputes, if they arise, can be resolved with as little inconvenience and delay as possible. To that end, the API Plan Rules provide a procedure whereby a Member may appeal an Initial Benefit Determination.
  1. THE INITIAL BENEFIT DETERMINATION
    1. 2.1. The Initial Benefit Determination is made entirely at the discretion of the Trustee and is based upon the guidance contained in the recommendation of the Trustee’s Medical Advisor (the“Recommendation”) and the API Plan Rules, and shall be consistent with the applicable laws of the Island of Guernsey (“Guernsey Law”) and the regulations set forth by the Guernsey Financial Services Commission (the “GFSC Regulation(s)”).
    2. 2.2. When deliberating how to implement the Recommendation, the Trustee give full consideration to any conflicts between the Recommendation and Guernsey Law, the GFSC Regulations and the API Plan Rules, all of which govern how the Trustee administers the Plan. In the event of a conflict between the Recommendation and any Guernsey Law, GFSC Regulation or API Plan Rule, the relevant Guernsey Law, GFSC Regulation or API Plan Rule shall govern.
    3. 2.3. In carrying out its respective responsibilities, the Trustee shall have the sole discretion to interpret the API Plan Rules and to determine the eligibility for an entitlement to any benefits under the API Plan.
    4. 2.4. The Trustee has sole discretion to interpret the API Plan Rules in deciding whether to allow any appeal, determining the outcome of any appeal, and make all benefit determinations.
    5. 2.5. Any interpretation or determination made pursuant to the discretionary authority of the Trustee shall be given full force and effect except as set forth to the contrary herein.
    6. 2.6. For the avoidance of doubt benefits under the API Plan shall only be payable if the Trustee, in its sole discretion, decides that the Member is entitled to them.
  2. SUBMISSION OF APPEAL.
    1. 3.1. Timeline: If a Member wishes to dispute an Initial Benefit Determination, he or she must initiate a request for appeal within 90-calendar days after receiving their Notice of Entitlement or notice that the claim has been denied. All requests should be submitted to API the Trustee using the following email address: [email protected]. Any request received by API after this 90-calendar day filing period will be denied.
    2. 3.2. Evidence:
      1. 3.2.1. The revocation of a Class I Medical Certificate by the GCAA (or other respective regulatory body) is made by an autonomous regulator and is based upon the Medical Certificate Revocation Documents.
      2. 3.2.2. It is outside the control and authority of API and the Trustee.
      3. 3.2.3. The Recommendation, which the Trustee considers in making its Initial Benefit Determination, is also made on the basis of the Medical Certificate Revocation Documents and any reports or correspondence furnished to the Trustee’s MedicalAdvisor by the review board of the GCCA (or respective aviation regulatory body) pursuant to their review (where applicable).
  1. 3.2.4. In support of any appeal, a Member may submit additional evidence, provided that any evidence presented by the Member must be received within the 90 calendar day filing period referenced in section 3.1 above and must pre-date the Revocation Date.
  2. 3.2.5. Any evidence which post-dates the Revocation Date would not have been considered by the GCAA (or other respective regulatory body) and, therefore, cannot beconsidered by the Trustee’s Medical Advisor or the Trustee.
  1. THE APPEAL PROCESS – STAGE 1 – TRUSTEE RE-EVALUATION.
    1. 4.1. Where a Member wishes to appeal an Initial Benefit Determination, he or she may do so by requesting the Trustee to exercise its discretion to conduct a re-evaluation of the Member’sclaim in the first instance.
    2. 4.2. The Trustee will only conduct a re-evaluation based upon the provision by the Member of new evidence (as described in 3.2 above), and only if the Trustee, in its sole discretion, decides on the balance of the evidence provided it is necessary to do so.
    3. 4.3. In conducting its reassessment, The Trustee may seek guidance or clarification from theTrustee’s Medical Adviser, the Consultants to the API Trust, the Plan administrators and its consultants, the accountants contracted to the Trust and / or the attorneys contracted by the API Trust (the Appeal Tribunal).
    4. 4.4. The Appeal Tribunal shall conduct a review of the Initial Benefit Determination, and such review shall be based on evidence the Member provides as noted in Section 3.2; the evidence may or may not be of a medical nature and is wholly at the discretion of the Member to provide.
    5. 4.5. During the Review:
      1. 4.5.1. No deference will be given to the Initial Benefit Determination; and
      2. 4.5.2. The Appeal Tribunal shall have the discretion to interpret the Plan.
    6. 4.6. When the review is complete, the Trustee shall, in its sole discretion, make a decision regarding the outcome of the review, will notify the Member of its decision and may, if so required, issue a revised Notice of Entitlement.
    7. 4.7. If the appeal is denied, in whole or in part, the Member will be informed of the specific reason(s) for the denial and a reference to the specific API Plan Rule or point of law or decision point on which the decision is based.
    8. 4.8. If the Member does not agree with the outcome of the review, the Member may request a review under Stage 2 of this process. In such instances, the Trustee shall have the sole discretion to allow or deny such appeal.
  2. THE APPEAL PROCESS – STAGE 2 – AEROMEDICAL ADVISORS ASSESSMENT.
    1. 5.1. The Member shall, at his or her own cost, choose an Aeromedical Advisor and notify the

      Trustee of the details of the chosen Aeromedical Advisor in writing.
    2. 5.2. The Trustee shall choose an Aeromedical Advisor and notify the Member of the details of the chosen Aeromedical Advisor in writing.
    3. 5.3. Both Aeromedical Advisors shall form a panel and review:
5.3.1. the Member’s records;
  1. 5.3.2. Medical Certificate Revocation Documents;
  2. 5.3.3. the findings of the medical panel of the GCAA (or other respective regulatory body) (as applicable);
  3. 5.3.4. the API Plan Rules; and
  4. 5.3.5. if necessary, examine the Member.
The Aeromedical Advisors may consult with licensed, board-certified medical specialists trained in the medical field in question if they encounter queries or specific medical or technical terms beyond the scope of their usual expertise.
  1. 5.4. Each Aeromedical Adviser shall draft a report of their assessments, following which they will arrange a mutually convenient time to discuss their respective reports and produce a joint report containing their joint and/or respective recommendations.
  2. 5.5. If the two Aeromedical Advisors come to an agreement:
    1. 5.5.1. they will send the joint report to the Member and to the Trustee;
    2. 5.5.2. the Trustee will consider the joint report and use its discretion to decide the outcome of the appeal;
    3. 5.5.3. the Trustee will notify the Member of its decision; and
    4. 5.5.4. if so required, issue an amended or new Notice of Entitlement.
6. THE APPEAL PROCESS – STAGE 3 – AEROMEDICAL ARBITRATOR ASSESMENT
  1. 6.1. If the two Aeromedical Advisors are unable to agree, they will mutually agree upon a suitably qualified Aeromedical Arbitrator.
  2. 6.2. The Member and the Trustee shall execute any agreements as may be necessary to implement the arbitration process.
  3. 6.3. The Aeromedical Arbitrator will examine:
    1. 6.3.1. the joint and individual reports of the Aeromedical Advisors;
    2. 6.3.2. all Medical Certificate Revocation Documents;
    3. 6.3.3. the findings of the medical panel of the GCAA (or other respective regulatory body) (as applicable);
    4. 6.3.4. the API Plan Rules;
    5. 6.3.5. any other relevant information pertinent to the claim, including the reports submitted by the two Aeromedical Advisors; and
    6. 6.3.6. if necessary, shall examine the Member.
  4. 6.4. The Aeromedical Arbitrator may also, if necessary, meet with the two Aeromedical Advisors ata mutually acceptable time and place to formulate their final opinion regarding the Member’sdisability and compliance with the benefit conditions and eligibility under the API Plan
Rules. This meeting may be held by means of a remote electronic communication system, including video or telephone conferencing technology or the Internet, or any combination.
  1. 6.5. The Aeromedical Arbitrator may also consult with licensed, board-certified medical specialists trained in the medical field in question if they encounter queries or specific medical or technical terms beyond the scope of their usual expertise.
  2. 6.6. The Aeromedical Arbitrator may also consult with the Trustee if they require clarification regarding the wording of the API Plan Rules.
  3. 6.7. Following a thorough assessment, the Aeromedical Arbitrator shall submit the final opinion in writing to the Member and to the Trustee.
  4. 6.8. The Member and the Trustee shall be bound by and shall implement such final opinion of the Aeromedical Arbitrator, and if required the Trustee shall issue a revised Notice of Entitlement.
  5. 6.9. Aeromedical Arbitrator Compensation: When the Aeromedical Advisors select an Aeromedical Arbitrator, the Aeromedical Arbitrator will submit an estimate of the fees of such evaluation to the Member and to the Trustee prior to any information being disclosed to him / her. Thereafter:
    1. 6.9.1. API and the Member will each post with an escrow agent nominated by the Trustee,an amount equal to half (1/2) of the Aeromedical Arbitrator’s fee.
    2. 6.9.2. If the final opinion of the Aeromedical Arbitrator is in favor of the Member, the Trustee shall pay the total cost of both Aeromedical Advisers and the Aeromedical Arbitrator’s fee and the Member’s portion of the funds in escrow will be released back to theMember.
    3. 6.9.3. If the final opinion is in favor of the Trustee, the Trustee shall pay half (1/2) of the cost of the Aeromedical Arbitrator. The Member will pay half (1/2) the cost of the Aeromedical Arbitrator; the total cost of the Aeromedical Arbitrator will be paid from the funds placed in escrow. The Trustee or the Member may request additional time to post funds in escrow but in no event, such funds shall be posted no later than 30 days from the date notified and no final opinion will be given by the Aeromedical Arbitrator until such funds have been placed in escrow.
7. THE RULES OF THE PLAN AND MEMBER ACCEPTANCE.
  1. 7.1. The current version of the API Plan Rules posted on the API website (as may be amended from time to time) shall be the valid controlling version. By virtue of the Member applying to become a member of API, the Member accepts and acknowledges that the API Plan Rules shall govern any decision regarding benefits.
  2. 7.2. This appeal process is a part of the API Rules.
  3. 7.3. In accepting the API Plan Rules, the Member agrees that the decision of the Trustee (or the Aeromedical Advisors or Aeromedical Arbitrator (where applicable)) reached as a result of the appeal process detailed herein with regard to his/her claim shall be final and binding, and the Member shall have no right to contest such decision(s) except as set forth below. The Member further acknowledges and agrees that the appeal process described herein is the sole and exclusive recourse for any and all controversies or claims arising out of or in connection with the API Plan and the Member expressly waives his / her right to file court actions disputing the decision of the appeal process except to enforce the appeal process and/or its legally binding decision except as set forth below.
8. APPEALING THE DECISION OF THE TRUSTEE FOLLOWING THE APPEAL PROCESS ALLOWED IN CERTAIN CIRCUMSTANCES.

8.1. In the event the Member is not satisfied with the decision of the Trustee, he / she may contest the decision before a competent court of Guernsey, based solely on the following grounds:
  1. 8.1.1. The Aeromedical Arbitrator failed to address the relevant Medical Certificate Revocation Documents and / or other relevant information pertinent to the claim, including the reports submitted by the two Aeromedical Advisors in reaching their decision. For clarity, in addressing the relevant Medical Certificate Revocation Documents and / or any other relevant information pertinent to the claim, the Aeromedical Arbitrator fulfills the obligation by considering the same regardless of the final opinion forwarded to the Trustee; or
  2. 8.1.2. There was a misapplication of relevant law or procedure by the Trustee and it can be demonstrated that the decision of the Trustee was arbitrary, capricious or failed to address the final opinion of the Aeromedical Arbitrator.
9. DEFINITIONS:
Aeromedical Advisor means a physician who is a licensed specialist, certified in aviation or

aerospace medicine. The Member and API may each select an Aeromedical Advisor.

Aeromedical Arbitrator means an independent physician who is a licensed specialist, certified in aviation or aerospace medicine and suitably qualified in aeronautical and medical arbitration, whose selection is mutually agreed upon by the Aeromedical Advisors.

Air Carrier shall have the meaning prescribed to it in the API Plan Rules.

API Plan Rules means the current version of the rules of the API Plan posted on the API website, asmay be amended from time to time (each individual provision a “Plan Rule”). For the avoidance of doubt the current version of the API Plan Rules on the date that a benefit claim is filed shall be the controlling version for the claim.

Initial Benefit Determination means the decision of the Trustee contained in a Notice of Entitlement to deny benefits to any one member or to award any Member a reduced benefit entitlement. SuchInitial Benefit Determination is based upon the recommendation of the Trustee’s Medical Advisor, the API Plan Rules, and shall be consistent with the applicable laws of the Island of Guernsey and the regulations set forth by the Guernsey Financial Services Commission.

Medical Certificate Revocation Documents means the medical documents and interviews submitted by the appropriate Air Carrier and medical service provider(s) contracted by the GCAA
or other respective regulatory body.

Notice of Entitlement shall have the meaning prescribed to it in the API Plan Rules.
Revocation Date means the date of the revocation of the Class I Medical Certificate by the GCAA or

other respective regulatory body.

Trustee means Sovereign Trust (Guernsey) Limited as Trustee of the Aircrew Protection International Trust.

Trustee’s Medical Advisor means the medical service provider(s) whose recommendation the Trustee considers when making the Initial Benefit Determination.
Thunderbirds54321 is offline  
Old 23rd May 2018, 11:52
  #237 (permalink)  
 
Join Date: Mar 2018
Location: Dubai
Posts: 7
Likes: 0
Received 0 Likes on 0 Posts
Hello!

We are pleased to announce you can now take your API membership with you when you leave Emirates and go to another carrier. We have updated the Rules on the website and under HOW API WORKS we have included a flowchart to easily explain the process.

The highlights are:
1. You must be a current member for 3 continuous years as of the date of your resignation from Emirates.
2. Your membership after Emirates is valid (you are covered) only while you are employed by another air carrier, however there is no time limit between leaving Emirates and going to another air carrier.
3. Your LSB continues to accrue after leaving Emirates.

If you have any questions or concerns, please do not hesitate to contact us on the API Website.
Switchboard is offline  
Old 31st May 2018, 11:17
  #238 (permalink)  
 
Join Date: Mar 2004
Location: Planet Earth
Posts: 576
Likes: 0
Received 0 Likes on 0 Posts
To set the record straight.

I joined LIPS now API many years ago after I joined EK not thinking I would ever need it, but still having comfort in the knowledge that I was covered.
Last year I got grounded and lost my medical permanently, a huge shock and a devastating blow as you can imagine. Once I had my letter of revocation from the GCAA I filed my claim with API, an easy process with no issues. EK were happy to provide me with a full copy of my medical records since my date of joining so I duly sent them off to Harvey Watt as requested. Research into HW lead me to discover that they are a professional medical organisation who have been in aviation medical and insurance business for many years.
It took several months for them to process my claim and contact was difficult, but there again they are dealing with API and the trust, not you!
Then came the long awaited email from API only to read that my claim had been denied due to a pre existing condition based on my date of joining, after close examination by myself I discovered that API's details were if fact incorrect and my joining date they had was wrong, they said they would look in to it. Within a few days they contacted was and apologised profusely admitting a mistake had been made and would resubmit my claim.

Needless to say it came back as all ok and my claim approved. I received many emails and phone calls from members of the API team apologising for the error that was made and the inconvenience to myself. My claim was back dated to the initial application and I'm now receiving full benefits. If you have a legitimate claim they will pay you, simple as that.

API is there for us the pilots and I would recommend anyone who is without cover to join right now!! You can't afford to be without it.
puff m'call is offline  
Old 31st May 2018, 12:48
  #239 (permalink)  
 
Join Date: Apr 2001
Location: overthere
Posts: 3,005
Likes: 0
Received 0 Likes on 0 Posts
I hope you are doing OK Puff.
donpizmeov is online now  
Old 1st Jun 2018, 11:10
  #240 (permalink)  
Thread Starter
 
Join Date: Aug 2008
Location: hong kong
Posts: 34
Likes: 0
Received 0 Likes on 0 Posts
Being a beneficiary you would say that wouldn’t you

Originally Posted by puff m'call View Post
To set the record straight.

I joined LIPS now API many years ago after I joined EK not thinking I would ever need it, but still having comfort in the knowledge that I was covered.
Last year I got grounded and lost my medical permanently, a huge shock and a devastating blow as you can imagine. Once I had my letter of revocation from the GCAA I filed my claim with API, an easy process with no issues. EK were happy to provide me with a full copy of my medical records since my date of joining so I duly sent them off to Harvey Watt as requested. Research into HW lead me to discover that they are a professional medical organisation who have been in aviation medical and insurance business for many years.
It took several months for them to process my claim and contact was difficult, but there again they are dealing with API and the trust, not you!
Then came the long awaited email from API only to read that my claim had been denied due to a pre existing condition based on my date of joining, after close examination by myself I discovered that API's details were if fact incorrect and my joining date they had was wrong, they said they would look in to it. Within a few days they contacted was and apologised profusely admitting a mistake had been made and would resubmit my claim.

Needless to say it came back as all ok and my claim approved. I received many emails and phone calls from members of the API team apologising for the error that was made and the inconvenience to myself. My claim was back dated to the initial application and I'm now receiving full benefits. If you have a legitimate claim they will pay you, simple as that.

API is there for us the pilots and I would recommend anyone who is without cover to join right now!! You can't afford to be without it.


Isn’t this infringing the first rule of Prune posting
  • No advertising or promoting of business/commercial ventures.
footballfanppl is offline  

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Thread Tools
Search this Thread

Contact Us - Archive - Advertising - Cookie Policy - Privacy Statement - Terms of Service - Do Not Sell My Personal Information

Copyright © 2022 MH Sub I, LLC dba Internet Brands. All rights reserved. Use of this site indicates your consent to the Terms of Use.