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

Decision detail

Summary

Mr T claimed on his income protection policy following a fractured toe injury, which Exeter Friendly initially accepted and paid for approximately 2 months. Exeter Friendly then terminated the claim based on their Chief Medical Officer's opinion that Mr T should be able to return to work. Mr T disputed this, arguing his GP evidence and job requirements were not properly considered. The ombudsman found Exeter Friendly's reliance on their CMO's independent medical opinion was reasonable and that the later GP letter Mr T provided did not demonstrate he was unable to work after the claim termination date, therefore not upholding the complaint.

The Ombudsman's reasoning

The ombudsman found that Exeter Friendly reasonably relied on their Chief Medical Officer's opinion that Mr T should be able to return to work within approximately 2 months of the injury. While the ombudsman acknowledged Mr T's GP evidence, she found it reasonable for Exeter Friendly to place less weight on GP evidence based on self-reporting compared to the CMO's independent medical opinion. The later GP letter provided by Mr T did not demonstrate he was unable to work after the claim termination date, so it did not alter the outcome.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website