Financial Ombudsman Experience (Investigator and Ombudsman decisions)

Teddg

Hi,

I’m just wondering if anyone has had a similar experience and if so what the outcome was please?

I’ve just learnt that the individual from the Financial Ombudsman who was dealing with my case was classed as an Investigator and as their decision has been challenged by the other party (an Insurance Company) they’ve had to escalate their decision to an Ombudsman to make a final ruling which will be binding.

I hadn’t appreciated that the person dealing with my case from the Financial Ombudsman, and who after a few weeks of deliberation ruled in my favour and issued their final findings to the Insurer instructing them to settle my case, actually now meant nothing.

The insurer has now rejected the Financial Ombudsman Investigator’s decision and the Investigator has now advised me they have had to refer the case to an Ombudsman to make a final binding decision on their judgement.

I’m just wondering if anyone else has had a similar scenario and if so did the Ombudsman agree with their own Investigator or did they overrule them?

All this refers to a relatively small claim from January 2025 but the outcome is of particular importance as it determines whether the condition the claim relates to means future claims can be made for the same condition.

Thanks

Isthisforreal99

Not sure how other people's experiencea will give you any assurance. Yes, decisions have been changed once the actual Ombudsman has reviewed the initial decision, if that is your question.

Voyager2002

My experience: the investigator ruled against me, but the actual Ombudsman found in my favour.

Teddg

Isthisforreal99 said:

Not sure how other people's experiencea will give you any assurance. Yes, decisions have been changed once the actual Ombudsman has reviewed the initial decision, if that is your question.

It wasn’t assurance I was seeking just experience of others in a similar position having not used the Financial Ombudsman before. It’s been a learning curve just to find out the Financial Ombudsman operate on two fronts, first their Investigator and secondly their Ombudsman which I’m assuming most end up being referred to since the first decision by the Investigator can just be objected to by either party.

Okell

In answer to your question - yes, the ombudsman can reverse a decision made by one of their investigators.

Whether they will in your case, nobody here can say as we don't know the facts of your complaint.

However, my understanding is that while the ombudsman's decision is final and binding on the insurance company, it is not binding on you.

If you think the ombudsman's complaint is wrong in law, I think it is still open to you to sue the insurance company.

(FWIW, my understanding - which might be mistaken - is that the FSO tends to reach decisions which it believes are "fair" to all the parties, but may not be strictly legally correct)

Teddg

Okell said:

In answer to your question - yes, the ombudsman can reverse a decision made by one of their investigators.

Whether they will in your case, nobody here can say as we don't know the facts of your complaint.

However, my understanding is that while the ombudsman's decision is final and binding on the insurance company, it is not binding on you.

If you think the ombudsman's complaint is wrong in law, I think it is still open to you to sue the insurance company.

(FWIW, my understanding - which might be mistaken - is that the FSO tends to reach decisions which it believes are "fair" to all the parties, but may not be strictly legally correct)

Hi, thanks. I wasn’t so much asking if they can reverse the decision, I’m aware they can, it was more just understanding what were peoples own experiences were in this scenario just for my own curiosity. Just doing a bit more research it seems only about 1 in 10 Investigator decisions get challenged and passed to an Ombudsman. In my case the claim is about £250 so quite small I would imagine compared to others that end up with the Ombundsman.

Teddg

I did some more research today and discovered you’re able to view the decision of every case decided by the Ombudsman so its’s a good insight into some decisions that are made and why. When I searched the cases related to my particular insurer Royal & Sun Alliance it noted 3874 cases.

Taking a look purely at cases between the 01.01.2025 and 08.08.2025 this involved 175 cases. Unfortunately it’s not apparent without reading every case whether the Ombudsman changed the decision of the Investigator’s original findings but only whether they Upheld the original claim (in this case 68) or did Not Uphold the original claim (107 in this period).

MyRealNameToo

Teddg said:

Hi,

I’m just wondering if anyone has had a similar experience and if so what the outcome was please?

I’ve just learnt that the individual from the Financial Ombudsman who was dealing with my case was classed as an Investigator and as their decision has been challenged by the other party (an Insurance Company) they’ve had to escalate their decision to an Ombudsman to make a final ruling which will be binding.

I hadn’t appreciated that the person dealing with my case from the Financial Ombudsman, and who after a few weeks of deliberation ruled in my favour and issued their final findings to the Insurer instructing them to settle my case, actually now meant nothing.

The insurer has now rejected the Financial Ombudsman Investigator’s decision and the Investigator has now advised me they have had to refer the case to an Ombudsman to make a final binding decision on their judgement.

I’m just wondering if anyone else has had a similar scenario and if so did the Ombudsman agree with their own Investigator or did they overrule them?

All this refers to a relatively small claim from January 2025 but the outcome is of particular importance as it determines whether the condition the claim relates to means future claims can be made for the same condition.

Thanks

The FOS operates a two tier system, all cases go to the first tier first, they have changed their name over time from Adjudicator to Investigator but it's the same people with different job titles. Both parties can accept or reject their decisions. 

If either party rejects it then goes up to an Ombudsman, their decision ultimately can only be accepted or rejected by the customer. If the customer accepts it then its legally binding on the financial services company, if the customer doesnt accept it then its the end of the road and the only option left for the customer is court.

Ombudsman generally agree with adjudicators/investigators but not always. Sometimes it's because new evidence comes to light in the process and other times they simply think they made an error. 

Every decision made by an ombudsman gets published online https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions and they almost universally state what the opinion of the investigator was and who disagreed with it as part of the preamble.

Decisions made by investigators alone arent put online. 

Teddg said:

I did some more research today and discovered you’re able to view the decision of every case decided by the Ombudsman so its’s a good insight into some decisions that are made and why. When I searched the cases related to my particular insurer Royal & Sun Alliance it noted 3874 cases.

Taking a look purely at cases between the 01.01.2025 and 08.08.2025 this involved 175 cases. Unfortunately it’s not apparent without reading every case whether the Ombudsman changed the decision of the Investigator’s original findings but only whether they Upheld the original claim (in this case 68) or did Not Uphold the original claim (107 in this period).

Its an ombudsman not the ombudsman... 

"The Ombudsman" is a bit of an awkward title anyway as there is the Chief Ombudsman who used to be referred to as "the ombudsman" and then there is the organisation as a whole being "the ombudsman". As noted decisions by investigators, which makes up the vast majority of cases, dont get published online.

Undervalued

Teddg said:

Isthisforreal99 said:

Not sure how other people's experiencea will give you any assurance. Yes, decisions have been changed once the actual Ombudsman has reviewed the initial decision, if that is your question.

It wasn’t assurance I was seeking just experience of others in a similar position having not used the Financial Ombudsman before. It’s been a learning curve just to find out the Financial Ombudsman operate on two fronts, first their Investigator and secondly their Ombudsman which I’m assuming most end up being referred to since the first decision by the Investigator can just be objected to by either party.

It is all clearly explained on their website.

Yes, that is how the process works, if either party chooses not to accept the initial investigator's decision. If I remember correctly, if a company chooses to refer the decision they have to pay an additional fee. No fee applies if the consumer makes that choice. Partly because of that I would assume that most cases "won" by consumers are not in fact referred.

Teddg

Voyager2002 said:

My experience: the investigator ruled against me, but the actual Ombudsman found in my favour.

Hi, thanks for the response to the specific question I asked. That’s a great result on your behalf. I’m obviously hoping they’ll upheld the original decision by the Investigator but will just accept whatever their findings are (would have also done the same if the Investigator had not upheld my claim and to be honest thought the insurer would have too given the low value). I think it’s likely to be a long drawn out affair now but just wondered in your experience how long an Ombudsman took to reach their decision? Thanks.

MyRealNameToo

Teddg said:

Voyager2002 said:

My experience: the investigator ruled against me, but the actual Ombudsman found in my favour.

Hi, thanks for the response to the specific question I asked. That’s a great result on your behalf. I’m obviously hoping they’ll upheld the original decision by the Investigator but will just accept whatever their findings are (would have also done the same if the Investigator had not upheld my claim and to be honest thought the insurer would have too given the low value). I think it’s likely to be a long drawn out affair now but just wondered in your experience how long an Ombudsman took to reach their decision? Thanks.

It's highly variable just like the investigator. 

Ombudsman are generally aligned to certain industries or products and types of complaints (you can see them all on https://www.financial-ombudsman.org.uk/who-we-are/staff/ombudsmen) so it depends on how niche your complaint matter is and how busy that particular niche is... Obvs when the likes of MSE start pumping out emails saying you've probably been missold XYZ then there is a spike of complaints which overwelms that area until more people can be recruited/cross trained. 

In broad terms you are generally looking at the same wait again as you had for the investigator but it can be much quicker or much slower.