Payment Protection Decision Reference 2022-0138

Case OutcomePartially upheld
Subject MatterPayment Protection
Reference2022-0138
Date21 April 2022
Finantial SectorInsurance
Conducts Complained OfClaim handling delays or issues,Complaint handling (Consumer Protection Code) , Dissatisfaction with customer service , Rejection of claim - fit to return to work
Decision Ref:
2022-0138
Sector:
Insurance
Product / Service:
Payment Protection
Conduct(s) complained of:
Claim handling delays or issues
Complaint handling (Consumer Protection Code)
Dissatisfaction with customer service
Rejection of claim - fit to return to work
Outcome:
Partially upheld
LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN
This complaint arises from the refusal of the Provider to admit and pay a claim made for
‘Total Disability’ on the Complainant’s sickness income policy.
The Complainant’s Case
The Complainant holds a sickness income policy with the Provider.
In April 2017, the Complainant became seriously ill and was hospitalised. In a letter to this
office, received on 2 March 2021, the Complainant submitted that he was “very ill for all of
that year and most of the following year”.
On 15 April 2017, the Complainant made a claim to the Provider for ‘Total Disability’
payment. The Provider made payments on this claim until September 2017, at which point
it sought additional medical records from the Complainant. The Complainant provided this
documentation on a number of occasions.
The Complainant states that the Provider used incorrect terminology in correspondence
with him regarding the policy. He states that he was referred to as ‘not economically

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