The Court of Appeal has dismissed Derek O’Regan’s appeal against a High Court decision that upheld the Financial Services Ombudsman’s rejection of a complaint about serious illness cover on insurance policies held with Zurich Life.
The judgment, delivered by Mr Justice Gerard Hogan on 7 June 2016, said the central issue was how far the High Court could review factual findings made by the Ombudsman after hearing witnesses. The court held that, where those findings are clearly stated and supported by credible testimony, review is generally limited under principles set out in earlier Supreme Court cases.
Mr O’Regan and his wife said they believed their policies included serious illness cover. Mr O’Regan was diagnosed with rheumatoid arthritis in 2011 and made a claim, but Zurich refused it, saying the policy then in force did not include that cover. The couple said they had not knowingly agreed to remove it and that their financial consultant had led them to believe that only cover for rare diseases would be excluded to reduce premiums. They also said they had not received the policy documents.
Zurich and the consultant disputed that account. The consultant said serious illness cover had not been selected in the 2008 and 2009 applications because the couple wanted lower premiums, and that he had explained their options. Zurich said the application forms and policy documents reflected the cover selected.
The Ombudsman initially rejected the complaint in 2012 after an investigation based on correspondence. The High Court set that decision aside in 2013 because the conflicting accounts required an oral hearing. After a hearing in December 2013, the Ombudsman again rejected the complaint, finding that the signed application forms requested life cover only, that the policy documents had been sent, and that the consultant was unlikely to have described an option to remove rare diseases while retaining serious illness cover.
The High Court upheld the Ombudsman’s decision in February 2015. The Court of Appeal agreed that the Ombudsman had heard the witnesses and was better placed to assess their evidence. It said the Ombudsman had given a clear reason for preferring the consultant’s account, including that the forms and policies did not provide for the option the couple described, and that they acknowledged signing forms without reading them.
The court concluded that the Ombudsman was entitled to make those findings and that the High Court was correct to uphold them. It dismissed the appeal. The judgment did not make a new determination of the insurance claim; it considered whether the Ombudsman’s findings could stand on appeal.