Payment Protection Decision Reference 2022-0235

• Case Outcome: Partially upheld
• Reference: 2022-0235
• Date: 18 July 2022
• Year: 2022
• Subject Matter: Payment Protection
• Finantial Sector: Insurance
• Conducts Complained Of: Maladministration,Dissatisfaction with customer service

Decision Ref:

2022-0235

Sector:

Insurance

Product / Service:

Payment Protection

Conduct(s) complained of:

Maladministration

Dissatisfaction with customer service

Outcome:

Partially upheld

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

This complaint arises from an Executive Income Protection Plan incepted in 2012 through

the Provider, an insurance intermediary. The Complainant was not the policyholder, but she

makes this complaint in her capacity as an actual or potential beneficiary of a “long-term

financial service” within the meaning of the Financial Services and Pensions Ombudsman

Act 2017. The Policyholder was the Complainant’s employer. The Complainant, as the life

assured, completed the application for cover through the Provider. The complaint is that the

Provider maladministered the application for the Executive Income Protection Plan.

The Complainant’s Case

The Complainant completed and submitted an income protection Claim Form to the Insurer

in May 2018. Following its claim assessment, the Insurer wrote to the Complainant on 23

July 2018 to advise that it was declining her income protection claim and voiding her cover

under the Executive Income Protection Plan from inception, as she had failed to disclose

her full medical history when applying for the cover. The Complainant sets out her complaint

in the FSPO Complaint Form she completed, as follows:

“I wish to complain about my broker… [with the Provider]. In Jan 2012 he completed

an application to [the Insurer] for an Income Protection Policy on my behalf. My

broker presumed that a PMA [(GP Report)] would be carried out, so he ticked the

Underwriting Medical questions all “No”, resulting in the Insurance Company

declaring that I had non-disclosure on my application form. My broker did not take

due care and attention in completing the application form”.

- 2 -

/Cont’d…

In her complaint papers to this Office, the Complainant also advised that:

“On the 26th January 2012 my broker asked me to sign a number of Applications for

[a different insurance provider] and for, income protection with [the Insurer]. He

never explained to me that this signature was for Declaration that medical questions

were correct, I understood my signature was just to start the process

for applying for the policies.

My Broker had completed a previous policy to [a different insurance provider] in

November 2011. I now believe that My Broker copied my details to my Application

form for Income Protection in January 2012 from my previous application to [the

different insurance provider] in November 2011, as all details are the same with the

same errors.

My Broker enquired if I was taking any medications for any complaint, the names of

my Doctor, I told him I was not taking any Medications, in great health and that the

most recent doctor was [GP 1] in 2010 and [GP 2] previous to that.

My Broker informed me that a PMA would be completed, so he never asked me any

Medical underwriting questions on the Income protection Form or on any of the other

applications, he was completing at the same time.

I trusted my Broker that he was doing his job correctly, and ensured that all was

correct to sign, and in good faith I signed without reading the part of the Applications

marked “X” for on each policy.

I never received a copy of my application Form or a copy of his online application form

for approval before they were submitted to [the Insurer].

In July 2018, once my claim was rejected, I asked my Broker for a copy of my

Application that he submitted to [the Insurer] in 2012. I noticed immediately; the

following were incorrect. Section 6 all Medical questions were marked NO incorrectly,

my weight was incorrect, my date of birth was incorrect, my start

date was incorrect also.

My Broker made the grave presumption in 2012 that a PMA would be carried out, so

he ignored the Medical underwriting questions and ticked No to every single

question, which has now resulted in [the Insurer] claiming non disclosures in my

income protection Application Form.

My Broker was unfamiliar with the Application form in 2012 and never realised there

was an option for a Tele medical until 2018 … On Friday 5th of April, I rang me (sic)

Broker to say “I needed to get him to answer some queries re the Income Protections

application form that he completed in 2012, that I need this for my appeal to the

[Financial Services] Ombudsman against [the Insurer]. My Broker replied “No

problem at all send me an email with your queries and I will meet you on Monday the

8th of April in my office and have the queries answered”.