Whole-of-Life Decision Reference 2022-0090

• Case Outcome: Rejected
• Reference: 2022-0090
• Date: 11 March 2022
• Year: 2022
• Subject Matter: Whole-of-Life
• Finantial Sector: Insurance
• Conducts Complained Of: Failure to process instructions,Claim handling delays or issues

Decision Ref:

2022-0090

Sector:

Insurance

Product / Service:

Whole-of-Life

Conduct(s) complained of:

Failure to process instructions

Claim handling delays or issues

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainants incepted a joint life assurance policy with the Provider on 1 October 1989.

The complaint relates to the Provider overcharging the Complainants for their policy, on the

basis that the Provider recorded the First Complainant as a smoker. He says this is incorrect

as he is not a smoker and that he declared in the Policy Application he completed on 5

September 1989 that he is not a smoker.

This Office, in accordance with Section 51(3) of the Financial Services and Pensions

Ombudsman Act 2017, can only consider conduct that occurred during or after 2002.

The Provider calculated the Complainants’ policy premium monthly, as per Para. 15, ‘Death

Benefit Charge and Policy Charges’, of the applicable Provisions, Privileges and Conditions

Policy Booklet. This complaint is that the Provider charged the Complainants the incorrect

premium since 2002, on the basis that it recorded the First Complainant as a smoker which

the Complainants say is factually incorrect.

The Complainants’ Case

The First Complainant, now age 80, says that he declared himself as a non-smoker when

completing the Policy Application to the Provider on 5 September 1989, with the Second

Complainant, now age 77, declaring herself as a smoker. In that regard, the First

Complainant answered the question “What is your average tobacco consumption per day?”

as “None” and the Second Complainant answered “10 per day”.