Employers Liability Decision Reference 2026-0041

• Case Outcome: Rejected
• Year: 2026
• Reference: 2026-0041
• Date: 13 March 2026
• Subject Matter: Employers Liability
• Finantial Sector: Insurance
• Conducts Complained Of: Rejection of claim - fit to return to work,Disagreement regarding Medical evidence submitted

Decision Ref:

2026-0041

Sector:

Insurance

Product / Service:

Employers Liability

Conduct(s) complained of:

Rejection of claim - fit to return to work

Disagreement regarding Medical evidence

submitted

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainant is a member of an income protection policy held with the Provider. The

Policyholder of the income protection scheme is her employer. The Complainant sustained

an injury to her back in or around March 2015 that left her unfit for work. The

Complainant received payments under the income protection policy from 30 March 2015

to 31 May 2019.

This complaint relates to the Provider's decision to terminate payment of disability benefit

to the Complainant on 31 May 2019.

The Complainant’s Case

The Complainant completed an Income Protection Claim Form on 10 April 2015 in which

she described her condition as persistent back pain due to slow degeneration of the spinal

joints. In addition, the Complainant specified that she was recommended to have a

thyroidectomy.

The Complainant indicated in the claim form that her condition prevented her from

performing her work-related duties which involved repeated heavy lifting, sitting and

driving for long periods of time, standing, etc.

- 2 -

/Cont’d…

The Complainant's GP ('Doctor A') completed the Healthcare Practitioner Report on 26

May 2015 and indicated that as a result of the Complainant's disability she was expected

to be absent from work for 6 to 12 months.

The Complainant's claim was accepted in June 2015. During the claim review process, the

Complainant attended medical examinations with various consultants nominated by the

Provider. The Complainant contends that in spite of providing letters from Doctor A, GP,

and Doctor B, Pain Consultant, in which they had both confirmed that she was not fit for

work, the Provider ceased the benefit payments in May 2019. The Complainant asserts

that Doctor B, Pain Consultant, and Doctor A, GP, will not "sign [her] off as fit for work."

The Complainant submits that she is "happy to return to work when [her] consultant and

GP approve so." She further submits that if her employer "wish for [her] to return to work

and [she is] unfit by [her] consultant and GP and if [she has] any accident or cause an

accident due to [her] disability is [her] employer happy under the healthy & safety to allow

this."

In her submission dated 9 February 2026, the Complainant says:

“I’m still out of work all these years later. With continued back problems & now going

to to me knee. I still attend [Doctor B, Consultant Pain Specialist]. I’m on anti

inflammatory medication. In the past few weeks I’ve been to a chiropractor.”

The Complainant wants the Provider to backdate the benefit payments from 25 April 2019

and "continually" pay her claim under the income protection scheme.

The Provider’s Case

The Provider submits that it received the Income Protection Claim form in April 2015,

followed by a letter from Doctor A, GP, on 26 May 2015 in which Doctor A, GP, indicated

that the Complainant's absence was due to neck and back pain "aggravated by fall at

work" and her condition would last 6 to 12 months.

The Provider submits that her claim was admitted in June 2015 as the Complainant

satisfied the definition of 'Disability' as laid down in the Policy Conditions.

The Provider submits that "the payment of benefit is conditional on the claiming member

continuing to satisfy the definition of Disability and we conduct periodic reviews on the

claimants ability to carry out the Material and Substantial Duties of their Normal

occupation." Therefore, the Complainant was kept under periodic reviews, which included