Multiple Products/Services Decision Reference 2023-0259

• Case Outcome: Rejected
• Year: 2023
• Date: 22 November 2023
• Reference: 2023-0259
• Subject Matter: Multiple Products/Services
• Finantial Sector: Insurance
• Conducts Complained Of: Mis-selling (insurance),Disagreement regarding Medical evidence submitted , Miscellaneous

Decision Ref:

2023-0259

Sector:

Insurance

Product / Service:

Multiple Products/Services

Conduct(s) complained of:

Mis-selling (insurance)

Disagreement regarding Medical evidence

submitted

Miscellaneous

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainants incepted a Life Assurance Policy with the Provider on 1 August 2001, a

policy which provides them both with life cover and independent specified illness cover.

The Provider is the insurer and underwriter of the policy. The complaint concerns the

Provider’s failure to advise the Complainants that the specified illness policy cover could

be altered or amended to include other or less serious specified illnesses which are

covered by newer policies which are now available from the Provider.

The Complainants’ Case

The Complainants say that they submitted a specified illness claim to the Provider on 13

January 2020, because the Second Complainant had received treatment and undergone

surgery for ductal carcinoma in situ, an early stage of breast cancer.

The Complainants note that the Provider wrote to them on 22 January 2020 to advise that

the claim was declined, because all tumours which are described as non-invasive

carcinomas in situ are specifically excluded from the cancer definition contained in their

Policy Terms and Conditions. The Complainant however say that in recognition of the fact

that the Second Complainant had undergone extensive treatment for her condition, the

Provider advised them that it had electronically transferred an ex-gratia payment of

€10,000.00 (ten thousand Euros) to their nominated bank account.