The High Court has rejected an appeal by Derek O’Regan and his wife against a Financial Services Ombudsman decision not to uphold their complaint about serious illness cover on their Zurich Life Assurance policies.
The appeal concerned policies taken out between 2005 and 2011. The O’Regans said they believed serious illness cover continued after earlier policies lapsed and new policies were arranged. In 2011, Mr O’Regan was diagnosed with rheumatoid arthritis and could no longer work as a plasterer. Zurich declined his claim, saying the policy then in force did not include serious illness cover.
The Ombudsman initially found the complaint unsubstantiated in July 2012. The High Court remitted it for an oral hearing because of conflicts in the accounts of what information the O’Regans gave their financial consultant, Pat Crowley, and what he told them about the cover. After that hearing, the Ombudsman again did not uphold the complaint, finding the signed application forms specified life cover only and that policy documents had been sent in the usual way.
The O’Regans said they had trusted Mr Crowley, believed only rare diseases were being excluded to reduce premiums, and did not understand that serious illness cover was absent. They also said they had not received full policy documents. Mr Crowley denied saying that rare diseases could be removed while retaining serious illness cover, and said the couple chose life-only cover to reduce costs. Zurich maintained that the forms and issued documents reflected the cover applied for.
The High Court reviewed the Ombudsman’s decision following the oral hearing; it did not rehear the complaint from the beginning. The judge said the court should defer to the Ombudsman on specialist matters, while reviewing factual conflicts with regard to the evidence and the limits of an appeal. She noted evidence accepted by the Ombudsman that the discussion focused on affordability, as well as the couple’s admission that they signed the forms without reading them.
Mr O’Regan also alleged on appeal that documents had been “doctored”. The respondent argued that this issue had not been raised at the oral hearing and that the parties used a complete set of documents by then. The judgment records that submission but does not make a separate finding on the allegation.
The court concluded there was no serious or significant error in the Ombudsman’s approach, handling of the hearing, assessment of the case or inferences from the evidence. It therefore rejected the appeal and could not lawfully disagree with the Ombudsman’s conclusions.