Many insurance complaints require us to reach a view about the policyholder's state of health. Disputes involving income protection policies, for example, often centre on whether a policyholder is so incapacitated that they cannot carry out their normal occupation, or on whether the policyholder is "permanently and totally" disabled. In this edition of ombudsman news we outline how we assess the (frequently conflicting) evidence about health that is presented to us in such disputes. We also provide several related case studies.
Disputes about amounts of cash paid into bank accounts can often cause emotions to run high. Typically, the customer has paid cash in - over the counter or via a deposit point - but then finds that the entire payment has gone missing, or that they have been credited with a smaller amount than they recall paying in. Both customers and firms tend to assume we settle such disputes on the basis of which "side" we believe. That is not what happens, and in this edition we explain the types of evidence we will want to examine when dealing with these complaints. Among our case studies on this topic we feature a lady who said she had paid £300 in to her bank account, but was told by the firm that it had no record of ever receiving her payment, and a gentleman who claimed to have paid in £1,000 in cash, but was credited with only £100.
Our usual round-up of recent investment case studies includes several complaints involving maturing pension policies. In one these, the firm told a customer that his wife had reported him dead. In another, the policyholder blamed the firm for "tipping off" his estranged wife that his policy had matured - thus "obliging" him to share the money with her.
Finally, as always we welcome your comments and queries. Each month we print the answers to a selection of recent questions in ask ombudsman news.
ombudsman news gives general information on the position at the date of publication. It is not a definitive statement of the law, our approach or our procedure.
The illustrative case studies are based broadly on real-life cases, but are not precedents. Individual cases are decided on their own facts.