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Group Income Protection through employer and FOS recourse


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First of all, thanks all for contributing to this forum, your time and efforts are highly appreciated!

 

I have received a Final Decision (rejection) from my employer's Group Income Protection insurance (UNUM)

I have asked my employer to appeal UNUM's decision through the FOS (as I am not the policyholder) but they have declined to do so and refused to send me a copy of their T&C with UNUM.

I am still off sick with bipolar and anxiety disorder and my claim is roughly around 16k£

 

Any suggestions? I feel like my only recourse at this point is against my employer

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Hi and welcome to CAG - Have you tried making a claim direct against UNUM? What did they say?

 

The FOS discusses this issue on their website: http://www.financial-ombudsman.org.uk/publications/ombudsman-news/32/ins-issues-32.htm. That link suggests to me that the FOS would take jurisdiction over a complaint bought by you personally in a case like this, as you are surely the beneficiary of the policy.

PLEASE HELP US TO KEEP THIS SITE RUNNING

EVERY POUND DONATED WILL HELP US TO KEEP HELPING OTHERS

 

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Here is the example from the FOS website:

 

32/10

group PHI policy - whether case within jurisdiction - employer was policyholder - whether employee an "eligible complainant"

 

Mr H worked at GJ Ltd, a large supermarket that offered private health insurance to its staff. After a period of ill health, Mr H put in a claim to the insurance firm. When the firm refused to pay, Mr H referred his complaint to us.

 

complaint within our jurisdiction

The firm argued that the complaint was not one we could deal with because neither GJ Ltd nor Mr H were eligible complainants; GJ Ltd because it was a commercial customer with an annual turnover of over £1million, and Mr H because the policyholder was GJ Ltd, not him.

 

We found that the complaint was within our jurisdiction. It was true that, because of its size, GJ Ltd was not an eligible complainant. However, Mr H was. Under the rules (DISP 2.4.12R), we were able to look at this complaint because " ... the complainant [was] a person for whose benefit a contract of insurance was taken out or was intended to be taken out".

 

It was clear that the policy was taken out for the benefit of GJ Ltd's employees, including Mr H. For the complaint to be within our jurisdiction, it was not necessary for Mr H to be the only person to benefit from the policy. The fact that the employer also benefited was immaterial.

PLEASE HELP US TO KEEP THIS SITE RUNNING

EVERY POUND DONATED WILL HELP US TO KEEP HELPING OTHERS

 

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Amazing steampowered thanks for your help! I missed that in my googling. I am emerging from a long period of time where everything seemed so overwhelming. Am onto it (and several other problems that accumulated)

Again thanks

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There is no list of covered and not covered conditions.

The only bit that refers to it is:

 

Definition of incapacity

this is the definition which we assess the claim against

the two most common definitions of incapacity are explained below

 

own occupation

you are unable to perform the duties of your usual occupation due to illness or injury. These are the duties that you need to do to effectively carry out your occupation that cannot be cahnged or removed

any suited occupation

You are unable to perform the duties required of an occupation that you are suited to in terms of your training, past experience or education due to illness or injury.

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