Tag Archives: enforcing a Financial Ombudsman’s Decision

The insurance saga

I took out a Permanent Health Insurance policy (PHi) in my early twenties, which would provide me with a proportion of my salary if I were ever too unwell to work.  If I hadn’t had this policy I would absolutely have lost my home when I got sick, because I don’t have a spouse’s income to rely on and state welfare payments like housing benefit are only given to people in rented accommodation not to those who own their homes (even if it’s the bank who actually owns it and you have a ginormous mortgage).

I started claiming on the policy in 1994 and it paid out without any problems until 2010, when all out of the blue the Insurance company wrote and said they’d been overpaying me and were reducing my weekly income by 1/3.  I can barely manage on the full amount so you can imagine my desperation.  To cut a very long story short, I referred the issue to the Financial Ombudsman Service (FOS).  For those outside the UK, the FOS is a regulatory body set up by the Government to help protect Consumers from unscrupulous and illegal business practices.  It consists of a team of Adjudicators who initially look at your case and try to resolve it.  If it can’t be resolved they refer it to the Chief Ombudsman.  The case took two horrendously stressful years to sort out but thankfully the FO Adjudicator ruled in my favour, her recommendation was agreed by my Insurers and my money was re-instated in full.

I was under the impression that this Financial Ombudsman’s Service decision was legally binding so thought the matter had been put to bed once and for all.  Think again Jak.

Since 2012 my insurers have been paying me what I’m owed, but in May this year all out of the blue I received a letter to say they had been overpaying me and were reducing my income by 1/3.  You have got to be freakin kidding me.

I wrote and told them that this matter had been settled by the FOS back in 2012 and, as this decision was legally binding they had to re-instate my money pronto.  They declined, so I had to start their formal complaints procedure.  Four months down the line and they are still “looking into it” despite the fact there is nothing to look into.

I contacted the FOS in June to ask their advice on the latest saga and they have been useless, ignoring my email and telephone messages.  Last week, in absolute desperation and already overdrawn at the bank, I found the email address of the Chief Ombudsman online and emailed her, outlining my case and begging for help.  Although I didn’t receive a reply, it must have reached her because on Tuesday I received a phone call from one of the Adjudicators apologising for the delay in answering my correspondence and offering to go over my case.

I was mortified to learn that the Adjudication back in 2012 is not legally binding.  Only an actual Chief Ombudsman’s Decision is legally binding and, as both the insurers and I had agreed with the Adjudicator’s recommendations, my case hadn’t had to go to the Chief Ombudsman.  In addition, the Adjudicator’s recommendation isn’t forward thinking – in other words it only works up to the date of the agreement between the parties.  My insurers could have changed their minds the week after and I would have had to start the process all over again.  It’s fucking outrageous and basically means an Adjudicator’s decision isn’t worth the paper it’s written on.

Because the previous FOS decision isn’t legally binding I can’t enforce it through the Courts, so I’ve had to make a totally new complaint and start the process all over again.  It took me 3½ hours Wednesday morning to gather all my paperwork together and email it to the Adjudicator (thankfully I still had most of the relevant documents scanned and saved on my laptop from last time), but there is no guarantee that this decision will go in my favour and I have no clue how long the process will take.

The stress of the 2010-2012 case was what caused my Mast Cell Disease to explode – I’d never had anaphylaxis before in my life until then.  God knows what’s going to happen this time as my health is much more precarious these days, not to mention the fact I’m now going through peri-menopause and have the added stress of caring for my parents.

I simply can’t believe I’m having to go through this a second time.  As if life with 3 exhausting, painful and crippling diseases isn’t hard enough these fuckers are trying to plunge me into poverty, yet are still happy to take my premiums every  month thank you very much.  Wish me luck, my financial future depends on the next few months.