Not upheld: Home insurance claim disputes complaint against Cirencester Friendly Society Limited

Decision detail

Summary

Mr S complained that Cirencester Friendly Society Limited failed to make a claims decision on his income protection policy. Mr S applied for the policy in January 2022 without disclosing health problems, but became unfit to work just nine days later with suspected fibromyalgia and mental health issues. Cirencester requested medical records, DWP information, employment history, and tax details before deciding the claim, which Mr S refused to provide. The ombudsman found that Cirencester's requests were reasonable given the unusual timing of the claim, the gradual nature of fibromyalgia, conflicting information about PIP entitlements and employment history, and the reference to an unknown third party requesting medical records before the claim was made. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found it unusual that Mr S quit his job and developed fibromyalgia symptoms only nine days after the policy started, particularly given that fibromyalgia typically develops gradually over time. The timing of the claim, combined with the varied symptoms that can lead to fibromyalgia diagnosis, justified Cirencester's request for full medical records to determine whether symptoms existed before the policy started. The reference to Company M (an unknown entity) before the claim was made raised legitimate concerns about whether Mr S had another insurance policy, which could affect entitlements. The conflicting information about PIP (initially claimed as received, later rejected) and the discrepancy between stated continuous employment and actual employment history justified requests for clarification. The ombudsman concluded that Cirencester had justifiable reasons under the ABI Code of Practice 2019 to request the information before making a claims decision.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website