why we publish case studies

from the insurance division

Many firms tell us they find the case studies in ombudsman news a very helpful way of keeping their staff up to date with ombudsman decisions. Of course, not all the cases will be directly relevant to every firm’s business – and some may appear to turn on a unique set of events. But the cases can all be useful in illustrating our general approach and giving examples of both good and bad complaints-handling practice among firms. The lessons to be learnt can help firms settle any disputes quickly and satisfactorily themselves, without the need for our involvement.

It appears, from a letter we were sent recently, that customers’ advisers sometimes pay more attention to ombudsman news case studies than the staff of insurers’ claims departments do. An insurance broker wrote:

‘… I recently obtained payment [for a client] of £27,000 under a personal accident policy. The man had held for some years a … personal accident policy that contained a £27,000 lump sum benefit for loss of sight in an eye. A splinter shot into his eye and after two years a claim was made for the capital sum…

‘[The insurer] requested an examination by their specialist and this was held 30 months after the accident. Despite repeated requests by the man’s solicitor [the insurer] refused to pay, contending that sight had not been lost as 3% remained.

‘Unwilling to bear Court Costs of further action by the solicitor, the man sought my aid … The same week you published an identical case [January 2001 – case 01/18 – where we concluded that an insurer should meet a claim for loss of sight from a lady who was left with only an estimated 2-3% vision after an accident]. The insurer duly paid but omitted to add £1,500 by way of an index-linked increase in the amount. When I drew this to their attention the further £1,500 was duly paid.’