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ombudsman publishes insurance complaints round-up

31 January 2001, ref FOS/01/01

Launching a new monthly publication, ombudsman news, the Financial Ombudsman Service today warned insurance companies about the widespread use of exclusion clauses.

Tony Boorman, Principal Ombudsman in the insurance division of the Financial Ombudsman Service, said:

Too often customers can feel misled when they study the small print. It is important that insurance companies express exclusions clearly. They should also draw the attention of policyholders to those exclusions at the point of sale.

Ombudsman News - published today - focuses on insurance-related complaints and includes the following case studies:

A customer who, following a car accident, suffered 97% loss of vision in one eye - but had her claim for loss of sight in the eye rejected by her travel insurer.
An insurance company which refused to pay for a car stolen from the owner's drive - because the owner left the keys in the car and the engine running while putting his briefcase indoors.
An extended warranty policy where repairs took months to complete.

This first issue of ombudsman news also looks at a range of complaints about medical expenses insurance, including:

An insurance company that refused to pay for a hip operation, saying the policyholder had already had this operation on her other hip and so it was a "pre-existing medical condition" and excluded from the policy.
A paralysed policyholder who was refused her physiotherapy costs because the insurance company said her condition was not "acute".
A man who was refused insurance cover for open heart surgery on the basis that his heart condition had become "chronic".

Commenting on these cases, Tony Boorman said:

Insurance companies need to be particularly sensitive in handling medical claims. They should have an active discussion with patients and their doctors before taking any decisions to withdraw cover.

Aimed primarily at financial services professionals and the consumer advice sector, each issue of the new publication, ombudsman news, will include case studies and a review of recent complaints trends and themes. This should provide a helpful source of reference for all those involved in how to complain and enable ombudsmen to feed their views directly into firms' own complaints-handling.

Future issues of ombudsman news will focus on banking-related complaints and investment-related complaints.

ends

notes for editors

The Financial Ombudsman Service has brought together eight complaints-handling schemes - including the Insurance Ombudsman Bureau (IOB), the Banking Ombudsman Scheme and the Personal Investment Authority (PIA) Ombudsman Bureau - to form a new single organisation.

Set up by law under the Financial Services and Markets Act, the Financial Ombudsman Service provides a single port of call for consumers with personal finance complaints ranging from household insurance and pension plans to bank accounts and stocks and shares.

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