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

Decision detail

Summary

Mr V complained that British Friendly unfairly settled his income protection insurance claim, which covered an absence from work between August and November. British Friendly paid benefit only until September based on available information, including a private GP consultation note indicating Mr V could return to work in September. The ombudsman found British Friendly acted within its terms and conditions by attempting phone contact and sending a claim form, and that its decision to assess the claim based on limited available evidence was reasonable. The ombudsman concluded that the GP evidence did not support incapacity beyond September and therefore upheld British Friendly's settlement decision as fair and reasonable under the policy terms.

The Ombudsman's reasoning

The ombudsman found that British Friendly acted within its terms and conditions by attempting phone contact without explicit instruction not to do so, and by sending a claim form thereafter. The ombudsman determined that British Friendly's decision to assess the claim based on limited available information was reasonable, particularly the private GP note from September which indicated Mr V could return to work. The ombudsman concluded that even with a sick note, the GP evidence did not support incapacity beyond September, and therefore British Friendly's settlement decision was fair and reasonable under the policy definition of incapacity.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website