Ombudsman slams insurers

The Irish financial ombudsman upheld 11 of the 21 major complaints it received from July to November

The biggest was a €325,000 (£274,000) specified illness cover that the ombudsman said had to be paid. The insurance company’s ‘loss of independence’ test was criticised.

The ombudsman said: “Following the accident the complainant had suffered a post-traumatic amnesic state for a period of six days. His first recollection was from a time almost a week after the accident, and his behaviour in hospital was erratic, showing concern for matters relating to his business, but being unable to retain any detail in relation to the chronology of his day, i.e. who had visited him etc. The complainant’s injuries had left him unable to bend, preventing him from sitting or standing in one position for any length of time, making it immensely difficult for him to move from a standing position to a lying down position and he complained of suffering pain to his groin when moving from a sitting position to standing. The complainant had reduced mobility and pain in his left arm, causing pain when lifting. He had paraesthesia in the fingertips of his left hand, though it was noted that he was right hand dominant. He had episodic sternal pain and stiffness in his big toe (which had been broken), which appeared to affect his ability to balance. The evidence also recorded that the complainant suffered frequent

nightmares and panic attacks; he continued to suffer severe affects of post-traumatic stress disorder while psychological therapy had been discontinued as it had proved emotionally difficult for him.”

The Ombudsman slated the company’s refusal to pay out and attacked many of the tests it used, particularly to assess metal health – the company insisted being able to use a mobile phone showed the claimant was perfectly able. “Such minor tasks were capable of completion by any average pre-teenage child, and could not in any way be indicative of a capacity for independent living,” the ombudsman ruled.

Other claims included a reduction from 50% to 20% in no claims bonus for minor car damage caused by a 70 year old was ruled too harsh and reduced to 5% for one year only, plus:

• A permanent health insurance benefit confusion resolved and €91,000 arrears paid.
• Personal accident benefit definition was not clear - 50% benefit to be paid.
• Travel Insurance definition of ‘relative’ / ‘step-parent’ case in which the ombudsman insisted on a 75% refund of €1,100 claim
• A cancellation of holiday due to pre-existing illness merited a 50% award of £1,500.