Not upheld: claim declined — misconduct exclusion complaint against Covea Insurance plc

Decision detail

Summary

Mr K claimed on his credit card payment protection insurance policy after losing his job in March 2023. Covea declined the claim on the basis that his unemployment resulted from his own misconduct, which is excluded under the policy terms. Although Mr K's employment was formally terminated for 'Some other Substantial Reason' (SOSR) due to an irretrievable breakdown in trust and confidence, the ombudsman found it reasonable for Covea to identify misconduct (inappropriate language and behaviour) as the underlying cause of that breakdown. Following an unsuccessful employment tribunal claim, the ombudsman upheld Covea's position that the policy exclusion for misconduct-related unemployment properly applied, and therefore did not uphold Mr K's complaint.

The Ombudsman's reasoning

The ombudsman concluded that although the formal reason for dismissal was SOSR, it was reasonable for Covea to look behind that classification and identify misconduct as a significant contributing factor. The ombudsman found that Mr K's language and behaviour, which the employer described as extreme and highly inappropriate, constituted misconduct within the meaning of the policy exclusion. The employment tribunal's judgment, while stating conduct was not the 'why' of dismissal, actually supported that conduct was the cause of the irretrievable breakdown. The ombudsman found it fair and reasonable for Covea to assess the available evidence and conclude that unemployment resulted from Mr K's own misconduct, thereby properly applying the policy exclusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website