Permanent Health Insurance is essentially a practical subject because, more so than in any other line of long-term business, an office is virtually in the hands of the policyholder once they have issued the contract. Of course a life assurance policyholder can always precipitate a claim, but this is rather a drastic move! How much easier merely to stay off work. And as Dr Peter Taylor wrote in 1974, “The time has come to admit quite openly that medical certificates are now, for all practical purposes, issued on demand.” (1) If we ever see in the United Kingdom the developments in medical malpractice suits current in the United States it is difficult to visualize any doctor being prepared to contradict a patient when the latter says he feels unfit to work.