Income Protection

An insurer must handle income protection claims fairly and not unreasonably reject a claim where medical evidence supports that the claimant is incapacitated due to an underlying illness rather than merely work-related stress.

An insurer must handle claims fairly and not unreasonably reject them, but an insured person must demonstrate they meet the policy definition of incapacity; a claim can be accepted based on a later deferred period if health deteriorates suf

An insurer must not unreasonably decline an income protection claim and must fairly assess whether the policyholder meets the definition of incapacity, placing the burden on the insurer to prove policy exclusions apply.

An insurer may cancel a policy and decline a claim if the consumer made a qualifying misrepresentation (deliberate, reckless, or careless) under CIDRA 2012, provided the insurer would have offered different terms or declined the policy had

A consumer must take reasonable care to disclose relevant medical history, but what constitutes reasonable care is assessed by the standard of a reasonable consumer in the context of how questions were asked and circumstances known.

A financial advisor must provide clear, fair and not misleading information about insurance policy terms and ensure suitability of advised sales, particularly regarding significant exclusions and limitations.

An insurer must handle claims promptly and fairly and should not reject a claim unreasonably, but may decline a claim if insufficient medical evidence is available to demonstrate the policyholder meets the definition of incapacity.

An insurer must fairly assess whether a policyholder was aware of a risk of unemployment during an exclusion period, rather than making assumptions based on job level or general public information.

An income protection claim must be declined if there is insufficient medical evidence to demonstrate that the claimant is totally incapacitated from performing the essential duties of their own occupation.

An insurer must fairly assess income protection claims based on whether the claimant meets the policy definition of incapacity, which requires continuous incapacity preventing performance of essential occupational duties, and must not unrea

A broker must accurately record a client's medical and employment history when applying for insurance on their behalf, and must ensure the policy sold is suitable for the client's needs.

A provider must communicate accurate information about policy values and must not mislead consumers through incorrect statements, particularly when the actual value is being depleted by charges exceeding premiums.

Insurers must handle claims fairly and not turn down claims unreasonably, and proportionate incapacity benefit is payable when a policyholder returns to work on reduced earnings directly as a result of incapacity.

An insurer must not unreasonably reject an income protection claim, and the consumer bears the burden of proving through medical evidence that they meet the policy definition of incapacity.

A policyholder must prove incapacity is defined by the policy terms as inability to perform their job role and any other occupation for which they are suited by education, training or experience, not merely being signed off work by a GP.

An insurer must handle claims fairly and may only turn down claims where the policyholder fails to provide sufficient medical evidence to demonstrate the claim meets the policy definition of incapacity.

An insurer is entitled to rely on medical evidence to determine whether a policyholder meets the contractual definition of incapacity at the point benefit ceases, and subsequent evidence must demonstrate incapacity at that specific point in

An income protection policy's incapacity definition excludes absences caused by workplace matters, and the policyholder must prove their absence was due to illness or injury rather than workplace issues.

An insurer may fairly decline an income protection claim if the medical evidence shows the absence was caused by work-related stress (an excluded peril) rather than an illness or injury, and there is insufficient objective medical evidence

An insurer may fairly terminate an income protection claim when medical evidence shows the claimant no longer meets the policy definition of incapacity, provided the claim has been regularly reviewed.

An insurer must not unreasonably reject or terminate a claim, and must base decisions on objective medical evidence that demonstrates the policyholder remains incapacitated as required by the policy terms.

An insurer may fairly apply policy terms requiring continuous evidence of unemployment status and satisfaction of eligibility requirements throughout the claim period.

An insurer may fairly decline an unemployment claim where the employer confirms the policyholder is in temporary work, which is excluded under the policy terms.

An income protection claim requires objective medical evidence to satisfy the policy definition of incapacity; self-reported symptoms alone are insufficient.

A firm must act honestly, fairly, and in accordance with the best interests of its customer when administering insurance policy terms.

A business cannot withdraw consent once given for the ombudsman to consider the merits of a complaint out of time.

An income protection policy requires objective medical evidence that the claimant is unable to perform the duties of their role to satisfy the incapacity definition.

An insurer may reasonably decline a claim where the policyholder cannot provide sufficient evidence to demonstrate they have a valid claim, particularly regarding the critical date they became aware of the risk of unemployment.