Not upheld: Travel / life insurance claim disputes complaint against Markel International Insurance Company Limited

Decision detail

Summary

C, a domiciliary care provider, complained that Markel incorrectly applied the Professional Indemnity section (with a 10% excess) rather than the Public Liability section (with £250 excess) to a claim arising from a customer's fall during assisted movement. The ombudsman examined the policy terms and relevant legislation including the Children and Social Work Act 2017 and CQC standards to determine what 'professional services' meant. The ombudsman concluded that C's activities in assessing needs and arranging care provision constituted professional services, distinct from the personal care provision itself. Since the legal claim focused on C's failure to arrange appropriately trained support workers rather than on the employee's actions in providing care, the Professional Indemnity section appropriately applied, and the complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied contractual interpretation principles to determine what a reasonable domiciliary care provider would understand 'professional services' to mean. The ombudsman distinguished between social work (assessment and care planning) which constitutes professional services, and personal care provision which does not. Since the legal claim focuses on C's failure to arrange appropriately trained support workers (a care planning/arrangement function) rather than on E's actions in providing physical assistance, the claim relates to professional services. Therefore, the Professional Indemnity section appropriately applies.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website