Luke Tucker Harrison, a co-founding partner of London disputes boutique Keidan Harrison, sent a letter before action last week to AXA PPP Healthcare in relation to a dispute over medical insurance coverage. But this is no ordinary case as he is the client and the stakes are life-threateningly high.

Harrison has been diagnosed with a rare cancer known as Epithelioid Hemangioendothelioma (EHE) and finds himself at the centre of a potentially precedent-setting legal challenge against his insurance provider over the coverage of critical medical treatment.

EHE is a cancer that arises from the blood vessels and can materialise anywhere in the body. It is described as a “one in a million” cancer which is extremely difficult to recognise. The disease has no cure and most usually occurs in the liver, lungs and bones, often in patients between the ages of 30 and 50. 

At the age of 43, Harrison’s diagnosis followed the discovery of liver lesions – tumours – through advanced imaging techniques. His medical team at London’s Royal Marsden Hospital, including renowned sarcoma oncologist Professor Robin Jones and liver surgeon Professor Long Jiao, recommended an immediate treatment strategy due to the growth of his tumours, leading to surgical resection of two 8cm tumours in August.

NanoKnife procedure

The medical urgency was clear: after the surgery, Harrison was advised that a persistent lesion necessitated further treatment via a method called irreversible electroporation, or IRE. The procedure, known by its commercial name ‘NanoKnife’, is widely used for prostate cancer and was deemed safe and effective for Harrison’s condition.

Harrison was told by a consultant radiologist, Professor Edward Leen, that an alternative treatment – ablation – carried with it the risk of damage to a vein, artery and bile duct which sit close to the lesion, leaving IRE as a safer and more effective treatment. 

The conflict with AXA arises from the insurer’s refusal to cover the IRE procedure. AXA, which is represented by DAC Beachcroft, maintains the treatment does not meet its criteria for “conventional treatment”, as outlined in its policy document.

AXA expresses sympathy towards Harrison’s situation. However, it argues that the procedure, while promising, lacks sufficient high-quality clinical trial evidence of its effectiveness and safety as a treatment for EHE, as per stringent standards which are guided by approvals from bodies like the National Institute for Health and Care Excellence (NICE), which regulates novel procedures. It maintains that this requires randomised control trials (RCTs).

Harrison’s legal team asserts that AXA is wrong to refuse cover for the IRE procedure, pointing out that RCTs are not mentioned in his policy. They rely on a Rare Cancer Europe (RCE) research paper which argues RCTs are not possible for many rare and ultra-rare cancers and that observational trials should be used, as, in the context of such cancers, they are high-quality clinical trials.

They also point out that NICE recognises the potential of IRE in specific cases like Harrison’s, where the tumour’s proximity to critical blood vessels makes other treatments risky. They urge AXA to treat rare and ultra-rare cancer patients fairly and not to discriminate against them. 

Letter of claim  

The letter of claim sent by Harrison’s firm to AXA emphasises the urgency of the situation, given a scheduled surgery date this week and the tumour’s growth. It outlines a potential legal action for a declaration that AXA’s insurance policy does cover the proposed IRE treatment under the circumstances and a claim for breach of contract focusing on the insurer’s duty to provide “peace of mind”, a principle for which damages can be claimed. 

Harrison has said he will donate any damages to an EHE charity along with any recoverable legal costs.

“When I was diagnosed with this ultra-rare cancer, I knew there would be challenges but I never thought that AXA would seek to avoid funding treatment in this way,” he said. “In taking this legal action, I hope that the scope of health insurance is clarified so that other rare cancer sufferers don’t have to go through the same experience as me.”

AXA’s response, articulated by its representatives, DAC Beachcroft, holds firm on its policy’s definitions and requirements. It suggests that any further dispute be taken to the Financial Ombudsman Service, a route that can take time, hence Harrison’s resort to potential High Court litigation.

Royal Marsden

For their part, the Royal Marsden’s team, led by Jones, have emphasised the necessity and urgency of the IRE treatment to AXA, due to the unique challenges posed by Harrison’s case. In correspondence, they point out that conventional treatments such as cryoablation could jeopardise critical vascular structures, potentially leading to severe complications or being outright unfeasible.

Jones also acknowledges that the lack of randomised controlled trials for IRE in treating EHE is a challenge commonly associated with rare diseases due to the small number of patients making it difficult to meet the stringent evidence standards often required by insurance policies for treatment coverage.

Harrison comments: “AXA’s assertion that only randomised controls trials are ‘high quality’ is not supported by the medical world, including Professor Jones, who is one of the world’s leading specialist EHE oncologist.”

A past chair of the Commercial Litigation Association, Harrison has been a member of the strategy group for London International Disputes Week since 2020 and from 2023 to 2024 was co-chair. He is also the co-editor of Global Legal Post’s forthcoming Law Over Borders guide to Restructuring and Insolvency.

Recognised for his commercial litigation work in the latest edition of Legal 500, the father and husband now finds himself at the intersection of law, medicine and the evolving nature of healthcare treatments.

Harrison’s case raises questions about the responsibilities of insurers to cover emerging treatments, especially when traditional options are insufficient. Moreover, the case spotlights one patient’s experience of the conflict between insurance protocols and the immediate need for advanced medical interventions.

For Harrison, the legal battle is not just about insurance coverage; it’s a fight for life, underscored by the real threat of an incurable cancer albeit one that can be treated effectively with IRE.

AXA PPP Healthcare declined to comment.