skip tocontent

ombudsman news

issue 111

August/September 2013

hearing trouble

We sold home contents insurance over the phone to an 80 year old woman in January this year. We didn't speak to our customer directly. She has trouble hearing so we spoke to her son.

We asked the question "have you made any claims in the last five years?" Her son repeated the question to her and she answered no. We ran through some more questions and cover was agreed.

She has now made a claim for a lost hearing aid worth £2,000. After looking into this, we have discovered that the customer actually made two other claims in the last five years, for damage to a carpet and another lost hearing aid. If we had known about these previous claims, we wouldn't have offered cover. We want to decline the claim and avoid the policy. What would the ombudsman think?

First, we would look at the evidence to see whether you asked the consumer a clear question, and whether the answer to this question induced you to offer her an insurance policy. This might mean listening to a recording of the sales call and checking your underwriting guide.

Then we would think about why your customer might have answered "no" when you asked her about previous claims. There could be a reasonable explanation for what she said. In which case if the non-disclosure was innocent, we would expect you to deal with the claim.

Other factors such as how long ago the claims were made - and how much they were for - could help us decide whether it was understandable that the consumer said no. You can find more information about our approach to non-disclosure in insurance contracts in our online technical resource.

putting two and two together

now that you're publishing individual ombudsman decisions in full, will you still be publishing the tables of complaints data about named firms?

Yes. We'll continue to publish a range of facts and figures about the complaints we've seen. We try and help people build a picture of what's happening by publishing data in different levels of detail.

Our annual review is our most comprehensive round-up of what we've seen.

We also continue to expand our technical resource on our website - which sets out our general approach to the cases we see. And you can now search the database of decisions made by our ombudsmen on individual cases.

In early March and early September we publish data showing the number and outcome of the cases we've handled. This relates to the 200 or so named financial businesses that together account for around 90% of our workload. We're planning to publish our next set of data in early September.

We also publish quarterly updates on our complaints numbers here in ombudsman news.

You can find all this information - and more - on the complaints data page in the publications section on our website.

image: ombudsman news issue 111

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.