After her income protection payments stopped because her insurer thought she no longer met the criteria, Ciara appealed the decision and was able to change the insurer's mind. But she came to us because of how they handled her situation and the considerable stress it caused.
Ciara was in receipt of income protection benefits, which she had been claiming under a group policy provided by her employer. The insurer reviewed her claim, taking into account surveillance evidence it had collected. It felt that she no longer met the policy definition of incapacity, so it wrote to her employer saying it was terminating her claim. Ciara appealed and submitted evidence from her treating doctor. On receipt of that evidence the insurer reinstated her claim and made back payments to cover the seven months that Ciara had been without benefit. It also paid interest on those payments.
But Ciara was still unhappy with the way the insurer had dealt with things. She explained that she was already fatigued by her condition and approaching her treating physician and writing a lengthy appeal to her insurer had put added stress on her. She said she was embarrassed by the suggestion to her employer that she was in fact fit to work. She was so concerned about her finances she considered a return to work even though she was signed off by her doctor and was still unwell. And she had to explain the situation to her family in order to ask for financial assistance – causing her further embarrassment. The insurer thought it had done enough by reinstating the claim.
What we said
We thought the insurer had made a mistake by solely relying on the surveillance footage to stop paying the benefit. We were satisfied that the insurer’s offer fairly compensated Ciara for the financial loss she’d suffered as a result of it terminating her claim. But we also thought the insurer’s mistake had had a significant impact on her health, and emotionally.
We felt that it should also compensate her for the considerable distress, upset and worry she had suffered when her benefit was terminated. We also took into account the inconvenience of having to approach her doctor to support her appeal – particularly when she was already fatigued by her condition. We recognised that she had been caused embarrassment by having to contact her employer to explain the situation and also by having to ask her family for money. Overall, we recommended the insurer should pay Ciara £700 for the impact of its mistakes.
Related case studies
Couple are unhappy their boiler repair is delayed over Christmas
Consumer’s boiler stops working but insurer disagrees that it’s an emergency