Employers Liability Decision Reference 2022-0131

Case OutcomeRejected
Subject MatterEmployers Liability
Reference2022-0131
Date11 April 2022
Finantial SectorInsurance
Conducts Complained OfMaladministration
Decision Ref:
2022-0131
Sector:
Insurance
Product / Service:
Employers Liability
Conduct(s) complained of:
Maladministration
Outcome:
Rejected
LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN
The Complainant, a public sector employee, incepted a Salary Protection Policy on 14
February 2011.
The Complainant is the Policyholder, and the Trade Union she is a member of is the
Grantee of the Salary Protection Scheme that her policy is incepted under. The Grantee
engages the services of an Insurance Brokerage to administer the Scheme on its behalf,
hereinafter ‘the Intermediary’.
The Provider was the Insurer of this Salary Protection Scheme, responsible for the
underwriting of applications for cover and assessing claims. The Provider ceased being the
Insurer from 1 December 2012, though it remains responsible for those claims that were in
payment at that time, for the duration of such claims.
This complaint concerns the Provider’s decision to cease payment of the Complainant’s
salary protection claim.
The Complainant’s Case
The Complainant completed a Claim Form to the Provider on 22 November 2011 advising
that she had been unfit for work since 17 May 2011 due to “sigmoid diverticular disease”.
2011
The Complainant’s GP completed and sent a Medical Certificate to the Provider on 2
December 2011 confirming that the Complainant was suffering from this condition.

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