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George and the insurance dragon
30/ 6/2008
AFTER a three-year battle with her insurance company, Felicity George has finally received a payout she was entitled to.
But she only got there by using the financial complaints system and refusing to give up.
Felicity contacted us in November 2005 asking for help. A year before, She was diagnosed with a cardiac/neurological condition known as postural orthostatic tachycardia syndrome. It causes extreme fatigue and, while she can be active for short periods, she needs to spend much of the day lying down.
Felicity's employer has a group income protection policy with Scottish Equitable.
When Felicity was diagnosed, her employer put in a claim to the insurer and Felicity was assessed by three different cardiologists - none of whom judged her fit to do her job. Despite this, Scottish Equitable rejected the claim.
Felicity found that Scottish Equitable had used a private detective to film her. Some of the footage showed Felicity driving short distances and walking.
Budge
Her employer wrote to appeal the decision, but Scottish Equitable would not budge. The insurer said: 'The file has been reviewed and the medical evidence on file indicates that Miss George is capable of a graded return to work.'
When Felicity contacted us she hadn't been paid for several months and was at a loss as to what to do next. Felicity believed that because this was a group policy through her employer she couldn't go to the Financial Ombudsman Service (FOS).
We contacted FOS and established that Felicity could take her case to it
The FOS adjudicator upheld her complaint, but Scottish Equitable appealed. Then an ombudsman also upheld the complaint, saying: "I am satisfied that the medical evidence supports the complainant as being unable to perform the material and substantial duties of her own occupation and that her claim for income protection benefit was valid from March 2005."
Scottish Equitable was told to pay the backdated claim and interest at eight per cent.
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