Partially upheld: Declined insurance application — underwriting decision and failure to communicate complaint against Zurich Assurance Ltd

Decision detail

Summary

Mr B applied for personal protection insurance including critical illness and income protection cover. Zurich declined both based on medical evidence indicating Mr B had been prescribed medication for an intention tremor. Mr B appealed and obtained a later GP letter suggesting the tremor was caffeine-related, but Zurich maintained its decision. The ombudsman found Zurich fairly declined income protection cover based on the contemporaneous medical evidence and underwriting considerations, but found Zurich at fault for internally reconsidering critical illness cover with an exclusion and failing to communicate this to Mr B. The ombudsman partially upheld the complaint and awarded £250 compensation for the distress and inconvenience caused by this communication failure.

The Ombudsman's reasoning

Zurich fairly relied on contemporaneous GP evidence indicating Mr B had been prescribed medication for an intention tremor when declining income protection cover, as this created an increased occupational risk given the nature of his job. The later GP letter expressing uncertainty and suggesting a caffeine-related cause did not undermine the earlier contemporaneous evidence and did not obligate Zurich to seek further medical investigations. However, Zurich's failure to communicate its internal decision to reconsider critical illness cover with an exclusion deprived Mr B of the opportunity to provide further information and caused unnecessary inconvenience.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website