Not upheld: Travel / life insurance claim disputes complaint against British Friendly Society Limited

Decision detail

Summary

Miss M complained about how British Friendly Society Limited handled her income protection insurance claim following absence from work as a cleaner due to a right hand medical condition. She argued she should receive benefit for the full duration of her absence and that her 'no income proof' policy meant the firm should not assess her income. British Friendly accepted the claim from 19 January 2024 to 25 March 2024, later backdating it to 1 January 2024, and refunded premiums taken in error. The ombudsman found British Friendly fairly declined December 2023 cover because Miss M's income had not reduced that month, fairly assessed the claim from January 2024 onwards when income did reduce, and reasonably relied on specialist physiotherapist evidence to conclude Miss M should have been able to return to work by 25 March 2024 (10 days after steroid injection treatment). The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that while Miss M held a 'no income proof' policy, this did not exempt her from demonstrating loss of income to satisfy the policy's definition of incapacity. British Friendly fairly declined December 2023 cover because Miss M's income had not reduced that month, including a regular standing order payment unrelated to work. The firm fairly accepted the claim from January 2024 when income did reduce and properly backdated it to 1 January 2024 based on bank statement analysis. Regarding the claim end date, the ombudsman found it reasonable for British Friendly to rely on the specialist physiotherapist's evidence (advising 4-10 days rest post-injection on 15 March) rather than the GP's later fit note, as the physiotherapist had specialist knowledge of the condition and provided the most up-to-date medical evidence following treatment. The ombudsman was satisfied there was insufficient medical evidence to support incapacity beyond 25 March 2024.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website