Upheld: Travel / life insurance claim disputes complaint against Unum Limited
Financial Ombudsman decision DRN-6354640 of 2026-07-03T00:00:00+00:00. Travel / life insurance claim disputes complaint against Unum Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6354640 |
|---|---|
| Decision date | 2026-07-03T00:00:00+00:00 |
| Firm | Unum Limited |
| Product | Life / income protection |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Unum Limited must: (1) Settle the claim in line with the remaining policy terms and conditions; (2) Pay 8% simple interest on payments from the date each payment was due until settlement; (3) Provide Mr K with a certificate showing any income tax deducted from interest so he can reclaim it from HMRC if appropriate. The ombudsman awards fair compensation calculated by settling the claim in line with policy terms, up to a maximum of £445,000, plus 8% simple interest. If the calculation exceeds £445,000, the ombudsman recommends (but does not require) Unum pay the balance. |
Summary
Mr K claimed on his employer's income protection policy due to mental and physical health issues, but Unum declined the claim. Following an ombudsman direction, Unum obtained an Independent Medical Examination from a Consultant Clinical Neuropsychologist, which identified significant cognitive impairment and concluded Mr K would have difficulty functioning in his senior role. Despite this report, Unum maintained their decision to decline. The FOS investigator upheld the complaint, but Unum disagreed and requested ombudsman review. The ombudsman found Unum acted unfairly by placing insufficient weight on the detailed IME report and rejecting Mr K's claim despite evidence he met the 'own occupation' definition of incapacity. The ombudsman upheld the complaint and directed Unum to settle the claim in line with policy terms, plus 8% simple interest.
The Ombudsman's reasoning
The ombudsman found that Unum acted unfairly in declining the claim. The IME report, conducted by a qualified neuropsychologist over three hours, provided substantial insight into Mr K's cognitive functioning and daily presentation. The ombudsman placed greater weight on the IME report than Unum's CMO review because the IME had conducted an extensive interview exploring Mr K's condition and medical history. Given Mr K's impaired cognitive functioning (speed of information processing, working memory, verbal fluency) and his senior, demanding role with high responsibility, the ombudsman was satisfied that Mr K met the 'own occupation' definition of incapacity. The ombudsman rejected Unum's criticism that the report was based solely on self-reporting and added little value, finding instead that it gave significant insight supporting Mr K's claims. The ombudsman also noted that Unum bore responsibility for the timing of the IME report, as a previous ombudsman had directed its completion, and therefore the passage of time should not be detrimental to Mr K.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Unum Limited, all decisions | 486 | 28% |
| Travel / life insurance claim disputes, all decisions | 21,318 | 31% |
| Life / income protection, all decisions | 10,722 | 20% |
Source
Read the original decision on the Financial Ombudsman Service website