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ombudsman news

issue 10

October 2001

why we publish case studies

Many firms tell us they find the case studies in ombudsman news a very helpful way of keeping their staff up to date with ombudsman decisions. Of course, not all the cases will be directly relevant to every firm's business - and some may appear to turn on a unique set of events. But the cases can all be useful in illustrating our general approach and giving examples of both good and bad complaints-handling practice among firms. The lessons to be learnt can help firms settle any disputes quickly and satisfactorily themselves, without the need for our involvement.

It appears, from a letter we were sent recently, that customers' advisers sometimes pay more attention to ombudsman news case studies than the staff of insurers' claims departments do. An insurance broker wrote:

"... I recently obtained payment [for a client] of £27,000 under a personal accident policy. The man had held for some years a ... personal accident policy that contained a £27,000 lump sum benefit for loss of sight in an eye. A splinter shot into his eye and after two years a claim was made for the capital sum...

"[The insurer] requested an examination by their specialist and this was held 30 months after the accident. Despite repeated requests by the man's solicitor [the insurer] refused to pay, contending that sight had not been lost as 3% remained.

Unwilling to bear Court Costs of further action by the solicitor, the man sought my aid ... The same week you published an identical case [January 2001 - case 01/18 - where we concluded that an insurer should meet a claim for loss of sight from a lady who was left with only an estimated 2-3% vision after an accident]. The insurer duly paid but omitted to add £1,500 by way of an index-linked increase in the amount. When I drew this to their attention the further £1,500 was duly paid."

Walter Merricks, chief ombudsman

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.