Whole-of-Life Decision Reference 2019-0268

• Jurisdiction: Ireland
• Case Outcome: Upheld
• Reference: 2019-0268
• Year: 2019
• Date: 01 August 2019
• Subject Matter: Whole-of-Life
• Conducts Complained Of: Misrepresentation (at point of sale or after),
• Finantial Sector: Insurance

Decision Ref:

2019-0268

Sector:

Insurance

Product / Service:

Whole-of-Life

Conduct(s) complained of:

Misrepresentation (at point of sale or after)

Outcome:

Upheld

LEGALLY BINDING DECISION

OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

Background

The Complainants incepted a life assurance policy in November 2004 with a financial service

provider (referred to hereafter as “the original provider”. The policy was transferred to the

Provider in or about May 2013. The Complainants contend that the policy provided Personal

Accident Benefit cover of €400 per week.

The First Named Complainant (the Complainant) made a claim for Personal Accident Benefit

under the policy in respect of an accident that occurred in August 2017. The Provider states

that the Personal Accident Benefit cover is not €400 per week but the lower of €719 or 50%

of the First Complainant’s normal weekly earnings at the time of making the claim.

The Complainants’ Case

The Complainants state that in November 2004 they were sold life assurance. The First

Complainant states that an agent visited his home and went through what he wanted in the

policy. Referring to the Statement of Suitability, the First Complainant states that he asked

if he could get accident cover of €400 per week and he says that this was sold to him as part

of the policy. In the annual statements the Complainants received from the Provider

between 2010 and 2014, it showed the sum of €400 per week for Personal Accident Benefit.

However, the First Complainant states that in 2017 this changed to €719 per week.