The High Court has dismissed an appeal by Kanagaratnam Baskaran against a decision of the Financial Services Ombudsman concerning Friends First’s termination of income protection payments. Mr Justice Binchy concluded that the Ombudsman made no error in finding that the insurer’s refusal of Mr Baskaran’s internal appeal was reasonable and supported by the evidence available to it in August 2015.
Mr Baskaran had worked as a manager of a homeless hostel in Dublin city centre. He claimed he became unable to work after a back injury in March 2011 and received benefits under an income protection policy. Friends First notified him in August 2014 that it considered him fit to work. It rejected his policy appeal in August 2015, relying on medical material that included a functional capacity evaluation and reports from consultants.
The Ombudsman investigated Mr Baskaran’s complaint and decided in April 2016 that the insurer’s decision was reasonable and adequately supported by the evidence available at the time. Mr Baskaran appealed to the High Court under section 57CL of the Central Bank Act 1942.
Among his grounds, Mr Baskaran argued that the Ombudsman wrongly excluded four medical reports supplied after Friends First’s decision, failed to account properly for reports supporting his claim, and should have held an oral hearing to address differences in medical opinion. He also challenged the Ombudsman’s treatment of private investigator reports and alleged an error in recording a consultant’s opinion.
The court held that the Ombudsman was reviewing the insurer’s decision on the information available to it, so the four later reports could not establish that Friends First had erred when it made that decision. Friends First had offered further independent orthopaedic and psychiatric assessments after receiving the reports. The judge found that Mr Baskaran had clearly refused the offer, while acknowledging that he considered the process was becoming “endless”. The court said the Ombudsman had no remit to carry out the further investigations Mr Baskaran requested.
The judge distinguished a conflict of medical opinion from a conflict of fact requiring oral evidence. He said the Ombudsman was not a medical expert tasked with resolving competing diagnoses, and found that an oral hearing would have been unnecessary and inappropriate. The challenge concerning the private investigator’s reports and the alleged factual error were not pleaded in accordance with the court rules; the judgment also rejected the investigator-report argument on its merits.
The court concluded that the Ombudsman’s process, considered as a whole, involved no error or series of errors. It dismissed the appeal. The ruling concerned the Ombudsman’s review of the insurer’s decision; it did not determine Mr Baskaran’s medical condition afresh.