Dishonourable conduct

Suts_2

I escalated my complaint to The Financial Ombudsman as my bank turned down my PPI claim. I decided to put in a complaint as on the one and only occasion we made a claim on our mortgage illness cover, it was rejected on the grounds that the illness was not covered, even though we were accepted with no pre-existing conditions. We didn't pursue it further at the time due to the illness being suffered. However, as part of my complaint to the FO, the insurance company has now paid out the claim (16 years after our mortgage has ended). The FO's adjudicator has not upheld our complaint, citing that one of the issues they consider is whether the cover was suitable for us, and as we made a claim and the insurance company has paid out, it proves the cover was needed, albeit the claim was originally rejected 16 years ago. Our claim was a genuine, honest claim submitted in good faith, but feel that it has been dealt with in a very deceitful and underhand way, and I plan to follow this up with the appropriate organisations and escalate it further with the FO. Has anyone else had a similar experience?

[Deleted User]

Suts wrote: »

I plan to follow this up with the appropriate organisations and escalate it further with the FO.

You won't be awarded any more money I'm afraid. The FOS has already rejected your complaint, so appealing their decision is very unlikely to be successful.

Out of interest, what "appropriate organisations" do you intend to contact?

Suts_2

The Financial Conduct Authority at least.

[Deleted User]

Suts wrote: »

The Financial Conduct Authority at least.

The FCA don't concern themselves with individual consumer complaints. The final arbiter of your complaint was and is the Ombudsman Service you've already approached I'm afraid.

dunstonh

The FO's adjudicator has not upheld our complaint, citing that one of the issues they consider is whether the cover was suitable for us, and as we made a claim and the insurance company has paid out, it proves the cover was needed, albeit the claim was originally rejected 16 years ago.

Basically, the fact that they have now paid the claim means that the reasons for the complaint are largely negated.

Our claim was a genuine, honest claim submitted in good faith, but feel that it has been dealt with in a very deceitful and underhand way, and I plan to follow this up with the appropriate organisations and escalate it further with the FO.

The fact the FOS rejected the complaint but got your claim paid out is effectively where the FOS service ends.

The Financial Conduct Authority at least.

They dont handle individual complaints. They look at complaints at a corporate level and not an individual level. They leave individual complaints to the FOS.

BooJewels

Suts wrote: »

I decided to put in a complaint as on the one and only occasion we made a claim on our mortgage illness cover, it was rejected on the grounds that the illness was not covered,

That doesn't sound like a PPI issue at all - PPI covers your monthly mortgage payments if you're unable to work due to illness or unemployment. They don't especially care about what's wrong with you, as long as you have a legitimate 'fit' note and are required to issue one every month to support continuing payouts for the duration of being off.

If they rejected your claim on the grounds that it wasn't a qualifying illness, then that sounds more like a critical/terminal illness claim and nothing to do with PPI and that being mis-sold. There is a published list of qualifying illnesses - the ABI list the minimum conditions that should be covered, but most organisations widen this a little. So your policy booklet would have included this list, so you could have seen before making the claim if your illness was likely to be covered. The list has improved over time, so maybe your condition wasn't covered at the time of the claim, but would be now, hence the retrospective payout?

We didn't pursue it further at the time due to the illness being suffered. However, as part of my complaint to the FO, the insurance company has now paid out the claim (16 years after our mortgage has ended).

The fact that you, perhaps understandably, chose not to pursue it at the time doesn't constitute wrong-doing by anyone else. But if you had, maybe you would have got a positive result at that time.

If it is a critical illness payout, chances are that it's a lump sum, possibly now with interest added and probably a significant amount more than any redress for mis-sold PPI. So it sounds like a result to me, frustrating though the timing proved to be.

takman

Suts wrote: »

I escalated my complaint to The Financial Ombudsman as my bank turned down my PPI claim. I decided to put in a complaint as on the one and only occasion we made a claim on our mortgage illness cover, it was rejected on the grounds that the illness was not covered, even though we were accepted with no pre-existing conditions. We didn't pursue it further at the time due to the illness being suffered. However, as part of my complaint to the FO, the insurance company has now paid out the claim (16 years after our mortgage has ended). The FO's adjudicator has not upheld our complaint, citing that one of the issues they consider is whether the cover was suitable for us, and as we made a claim and the insurance company has paid out, it proves the cover was needed, albeit the claim was originally rejected 16 years ago. Our claim was a genuine, honest claim submitted in good faith, but feel that it has been dealt with in a very deceitful and underhand way, and I plan to follow this up with the appropriate organisations and escalate it further with the FO. Has anyone else had a similar experience?

You say you didn't pursue it further at the time because you were suffering with illness, but why didn't you pursue it after you got better or asked your partner to pursue it?.