Personal Accident Decision Reference 2025-0223

• Case Outcome: Substantially upheld
• Year: 2025
• Reference: 2025-0223
• Date: 23 December 2025
• Subject Matter: Personal Accident
• Finantial Sector: Insurance
• Conducts Complained Of: Claim handling delays or issues,Delayed or inadequate communication, Failure to process instructions in a timely manner

Decision Ref:

2025-0223

Sector:

Insurance

Product / Service:

Personal Accident

Conduct(s) complained of:

Claim handling delays or issues

Delayed or inadequate communication

Failure to process instructions in a timely manner

Outcome:

Substantially Upheld

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainant purchased his policy 'Accident Disability Plus Plan' in 2008. The

Complainant submitted an Accident Claim Form to the Provider on 21 June 2021.

The Complainant’s Case

The Complainant submits that on 11 February 2021, he had a fall at his home and

sustained injuries to his head, upper body, and hand/wrist, along with other personal

injuries. He says he attended the local Accident and Emergency department the same day

and continued to attend his own General Practitioner (GP) for three months after the fall.

The Complainant submitted an Accident Claim Form to the Provider on 21 June 2021,

which included his authorisation to "obtain his medical data from the various centres

where he was treated". The Provider acknowledged receipt of the claim form by way of

letter dated 24 June 2021, in which the Provider indicated that it would be in contact with

the Complainant in "no more than two weeks..." from the date of its correspondence.

The Complainant explains he sent follow up emails on 25 July 2021, 30 July 2021 and again

on 10 August 2021.