Income Protection and Permanent Health Decision Reference 2022-0313

Case OutcomeRejected
Subject MatterIncome Protection and Permanent Health
Reference2022-0313
Date08 September 2022
Finantial SectorInsurance
Conducts Complained OfDissatisfaction with customer service ,Claim handling delays or issues, Delayed or inadequate communication
Decision Ref:
2022-0313
Sector:
Insurance
Product / Service:
Income Protection and Permanent Health
Conduct(s) complained of:
Dissatisfaction with customer service
Claim handling delays or issues
Delayed or inadequate communication
Outcome:
Rejected
LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN
The Complainant is a voluntary member of a Group Salary Protection Scheme since 1
November 1986, which provides life, income protection and specified illness cover. The
Grantees of this Scheme are a named Trade Union, the individual members of which can
organise cover through the Respondent Provider which is a financial broker engaged by the
Grantees to be the Scheme Administrator.
The Insurer is responsible for underwriting the applications for cover and assessing claims.
This complaint concerns the suggested poor customer service the Provider demonstrated to
the Complainant when she had cause to claim under the Scheme.
The Complainant’s Case
The Complainant, a primary school teacher, was medically certified as unfit for work since
11 June 2014. The Complainant says she had fallen severely ill due to numerous conditions
that included post-surgery complications and that she suffered from nerve damage,
resulting in her having difficulty thereafter, using one of her feet.
The Complainant says she telephoned the Provider on 20 February 2015 to query making
an income protection claim under the Group Salary Protection Scheme. The Complainant
subsequently on 25 February 2015, completed an Income Protection Claim Notification
Form to be sent to the Insurer.
- 2 -
/Cont’d…
The Complainant says that as part of the assessment of her income protection claim, she
had a tele-interview with a specialist nurse on 13 March 2015 and, in that regard, in her
letter of complaint to the Provider dated 29 July 2019, she submits that:
[The] interview by phone is too long (over 2½ hours) and it is unfair to someone who
is ill, weak and recovering from serious illness and trauma to endure. Then the client
has to edit the transcription which demands energy and concentration. A face to face
meeting with a health professional would be much more appropriate and
manageable in my case at least and I am curious why [the Provider] do not offer this
to their clients?”
Following its assessment, the Insurer admitted the Complainant’s income protection claim
from 2 May 2015 and the claim has remained in payment since.
The Complainant says the Provider wrote to her on 20 May 2015 to query if she had applied
for or been granted ill-health early retirement, and in her letter of complaint to the Provider,
she submits that:
“I was only a few months in receipt of [Income] Protection Benefit when the Provider]
at the behest of [the Insurer] wrote asking me if I was considered Ill Health
Retirement. This was inappropriate and an unfair imposition on me as I was
struggling to overcome life-changing events and needed time to process and accept
what had happened while at the same time, trying to recover medically and
physically. I certainly did not need [the Provider]…niggling and troubling me with a
possibility that I was not yet ready to countenance and could have plunged me into
the depths of despair”.
In her letter to this Office dated 18 November 2020, the Complainant submits that the
Insurer asking her about ill-health retirement was “…a ploy to direct clients to consider or
apply for Ill Health Retirement which would accordingly reduce [the Insurer’s] pay out”.
The Complainant says her employer granted her early retirement, on ill-health grounds from
16 March 2016.
The Complainant says she attended a retirement planning seminar in February 2016, where
she first learned that given her medical diagnosis, she may also be eligible to claim a once-
off specified illness benefit lump sum of 25% of her annual salary, under the G roup Salary
Protection Scheme and in her letter of complaint to the Provider, she submits that:
“I was not advised of [Specified] Illness Benefit when I made my request for salary
protection benefit by phone [to the Provider] on 20/2/2015”.
In that regard, the Complainant says that the Provider failed to properly advise her of her
entitlements under the Scheme, during her telephone call to it on 20 February 2015.

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