Capital One PPI claim rejection

grumpyawldwifey

My mum had a number of cards with PPI as she was under the impression that it was compulsory.
ALL of the companies that we have complained to have accepted her claims and paid up EXCEPT Capital One.
Their reasons for rejection are:

• it was sold on an unadvised basis (a postal application) so they were unable to provide advice
• she ticked the box voluntarily
• details of the policy were provided with the application (a copy of which they've sent us with the rejection but they do not match the copy of the Ts & Cs they've also sent us a copy of because the leaflet mentioned sickness cover but the Ts& Cs don't, they only mention critical illness)
• the leaflet detailed exclusions for pre-existing conditions (she had back problems and hypertension) but the leaflet is ambiguous in that it insinuates that it only relates to pre-existing conditions with which she has suffered in the last 12 months
• as there was no telephone conversation, the cooling off period was not highlighted

As I mentioned before, it would appear that the copies of the documents they've sent are for differing PPI policies.

Has anyone else had dealings like this with Capital One?
Can you help me word my complaint to the Ombudsmen?

Thanks in advance
Sue

dunstonh

Has anyone else had dealings like this with Capital One?
Can you help me word my complaint to the Ombudsmen?

Cap One isnt the issue. They have a good reputation for complaints handling and are a very low overturn rate at the FOS because of that. The problem appears to be a lack of a reason for complaint.

it was sold on an unadvised basis (a postal application) so they were unable to provide advice

This is the killer. It was a postal application. So, no-one was involved to mis-sell it.

the leaflet detailed exclusions for pre-existing conditions (she had back problems and hypertension) but the leaflet is ambiguous in that it insinuates that it only relates to pre-existing conditions with which she has suffered in the last 12 months

Pre-existing conditions are not really an issue if they are not major. It doesnt stop her claiming on the policy for unrelated conditions for example.

What exactly are her complaint reasons as Cap One seem to have given a comprehensive rejection that you cant see the FOS overturning based on what you have said so far?

Insider101

It's not ambiguous. What it states is that the exclusion relating to pre- existing medical conditions will not apply if you have not had symptoms or seen a doctor for 12 months before the policy start date. It's a fairly common clause and also a pretty clear one.

grumpyawldwifey

Thanks for your responses.
Mum's main complaint is that she was ignorant. She always thought her application wouldn't go through without PPI and she wasn't told otherwise. In fact, one of her other complaints to another company was based on her being actually told by the seller that it wouldn't- that has been repaid. She was informed in the Ts & Cs that she could cancel but not that the policy wasn't necessary.
Would this be a substantive reason?
Also, on examining the copies of the insurance documentation that they have sent with the rejection; one leaflet that they say would have been with the application form, the other, the policy Ts & Cs that they say were sent with her card, appear to be for 2 different types of policy. The first is the standard sickness, redundancy type of PPI that would have ceased to be valid when she reached 65 (or retired), the second is a critical illness policy that would cover her until she was 70. My mum would not have taken out critical illness insurance she states. She retired at 64 and continued to pay the insurance until she was 69.
If she had the first, would it have been her responsibility to cancel it on retirement or should the company have some method of flagging up that a client has reached retirement age and cancelled it for her?
Sorry for all the questions

-taff

If she ticked a box, she bought it, it wasn't sold to her. Her complaint is likely to fail at the FOS, Capital One have the lowest overturn rate.

What gave her the impression that postal application success rested on ticking the box?

grumpyawldwifey

Thanks Taff, I thought that too but she has had some paid back that were obtained in the same way so she thought they'd all be that easy.

Can you advise regarding the copies of the two policies that were sent though? They appear to be completely different types of insurance to me. Also regarding the age thing?

Sue

Insider101

sueyw wrote: »

Thanks for your responses.
Mum's main complaint is that she was ignorant. She always thought her application wouldn't go through without PPI and she wasn't told otherwise. In fact, one of her other complaints to another company was based on her being actually told by the seller that it wouldn't- that has been repaid. She was informed in the Ts & Cs that she could cancel but not that the policy wasn't necessary.
Would this be a substantive reason?

If she was actually informed by the seller that the application would not be approved without PPI (and this was not actually the case) then that is misselling (though difficult to prove). On the other hand if she has just inexplicable got that idea into her head without being told so by anyone, Capital One can't be held responsible for that. So no it isn't a valid reason.

Also, on examining the copies of the insurance documentation that they have sent with the rejection; one leaflet that they say would have been with the application form, the other, the policy Ts & Cs that they say were sent with her card, appear to be for 2 different types of policy. The first is the standard sickness, redundancy type of PPI that would have ceased to be valid when she reached 65 (or retired), the second is a critical illness policy that would cover her until she was 70. My mum would not have taken out critical illness insurance she states. She retired at 64 and continued to pay the insurance until she was 69.

Phone them and ask for clarification.

If she had the first, would it have been her responsibility to cancel it on retirement or should the company have some method of flagging up that a client has reached retirement age and cancelled it for her?
Sorry for all the questions

It's really her responsibility. Some companies will have systems in place to flag these up and automatically cancel. This tended to become more common in the 00s and post regulation. Prior to that it was a lot more emphasis on the buyer.