The Financial Ombudsman Service (‘FOS’) is an independent body that helps to resolve disputes between consumers or small businesses and financial institutions, including insurers. The FOS will look at all the information and individual circumstances of the complaint.
While they take the law into account when coming to their decisions, they also consider what is fair and reasonable in the circumstances and they are not obliged to follow the strict letter of the law. The courts have a very limited jurisdiction to overturn FOS rulings.
Not all policyholders have the legal right to refer a complaint about an insurer’s decision to the FOS. A referral might be part of a broader claim strategy, alternatively, it might be the only means available to a policyholder to have the matter reviewed independently. Strategic advice is required at the outset.
The FOS’s ability to ignore the full rigour of insurance law makes it a good option for certain issues and a less attractive option for other disputes. Policyholders often assume wrongly that they can simply provide their earlier complaint to an insurer about a coverage decision and expect the FOS to reach the “right decision” purely through the simple optic of what is “fair and reasonable”. That approach is overly simplistic and overlooks the importance of providing the FOS with evidence and/or the art of influencing the outcome. Then again, some claims simply should not be paid and that’s why advice is required.
We are here to help.
Recent examples of work:
- Acted for a small house builder with its complaint against an insurer that it unfairly rejected a Contractors All Risks claim relying on various exclusions. After making a detailed submission to the Ombudsman, the insurer was obliged to indemnify the policyholder and pay the claim.
- Acted for private individuals who had their home policy avoided for alleged dishonesty following a serious fire. After making a detailed submission supported by evidence, the Insurer was obliged to reinstate the policy and provide a full indemnity to the policyholders which then resulted in a successful s.13 claim against the Insurer for consequential losses.
- Acted for an individual who had his Ferrari 458 stolen in a robbery. His motor insurer avoided his motor policy alleging it was a fraudulent claim. We were successful in persuading the FOS to uphold his complaint, reinstate the motor policy and make a full payment for the value of the stolen Ferrari and interest.
- Acting for a small business to raise a complaint with the Financial Ombudsman Service against its insurer following the avoidance of its commercial Property policy on unfounded grounds of misrepresentation and failure to make a fair presentation of the risk.
- Acting for a small manufacturing business in a complaint to the Financial Ombudsman Service against its property insurer after the declinature of a claim made against the policy, following a flood at the client’s property.
