The Financial Ombudsman Service (Fos) has ordered insurer Scottish Provident to pay compensation to a client after a two and a half year battle over his income protection policy, which the firm had refused to pay out on saying that the terms had been “misunderstood”.
The decision, announced today (2 February), means that the client, Chris Hargreaves, will be paid from the beginning of his claim from 21 July 2009 to 19 September 2009, as well as for the period from 20 September 2009 to 31 January 2010.
Interest should be added to the payment made at the gross rate of eight per cent per year from the date the claim was resubmitted to the date of settlement, the Fos ordered. Scottish Provident have also been told to pay Mr Hargreaves £100 compensation for the “distress and inconvenience” caused.
Scottish Provident had previously refused to pay out on Mr Hargreaves’ income protection policy, despite doctors confirming that Mr Hargreaves is unable to work, claiming that the terms of his policy have been misunderstood.
Responding to today’s judgement, the company said that it would “abide by the decision of the Ombudsman”, but that the case “highlighted an industry-wide issue around customer understanding of certain protection policies”.
Mr Hargreaves was diagnosed with continued internal bleeding more than two years ago and claimed that he evidenced that he could not perform two of the six tasks listed in the policy.
Mr Hargreaves said that he was unable to walk 200 metres on a level surface with a stick or other aid without discomfort, nor was he able to pick up a 1kg weight from table height and carry it for 5 meters, claims that were confirmed by medical consultants.
He submitted a claim in September 2009, which would have paid out at a rate of £8,400pa until his policy expired in July 2010.
However, the claim was refused by Scottish Provident in December 2009, with the firm saying that there was “no objective evidence” that Mr Hargreaves was ‘continuously’ unable to perform the tasks.
The insurer added that insufficient evidence had been provided by doctors as to his inability to perform the tasks stated, specifically stating that there was no explanation of why the tasks were not achievable.
In July 2010, the case was sent to the Fos, which initially agreed with the firm that there was not enough evidence. The Ombudsman later referred the case back to the insurer after receiving additional material from Mr Hargreaves.
In August 2010, further evidence was received by Scottish Provident and the insurer offered to pay ex-gratia payment of £819, as it accepted that there would have been a degree of restriction of ability while Mr Hargreaves was in hospital, which was refused.
A new complaint was made to Fos after the claim was again refused by Scottish Provident, with the adjudicator finding in favour of Mr Hargreaves in a decision dated August 2011.
Today’s decision stated that while there was little objective medical evidence, such as a functional capacity evaluation, on balance the ombudsman said he was “persuaded by the supportive comments of Mr Hargreaves’ various doctors, which indicate that he could not perform the work tasks”.
A spokesperson for Scottish Provident said: “The Ombudsman has upheld Chris Hargreaves’ complaint against us and decided that he did satisfy the criteria to make a successful claim.
“Scottish Provident will of course abide by the Ombudsman’s decision and will arrange for payment of the full amount awarded by the Ombudsman. We wish Mr Hargreaves well for the future.”
