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Permanent Health Insurance payments wrongfully terminated

28 April 2010

We acted for an individual who suffered from serious depression and was therefore unable to carry out his senior position at his employer. He started receiving benefits under a permanent health insurance policy offered by his employer.

After several months the insurer decided to stop paying our client benefits under the policy because they said they did not accept that he was unable to perform his job. They based this on the fact that they did not think he wanted to work for his employer anymore which is what was stopping him coming back and that he wasn’t really ill. They had used a private investigator to ‘spy’ on him and had seen him out on his bike, which had in fact been recommended by his doctor to help him recover.

We obtained further medical evidence which clearly showed that he was unable to work and appealed the insurer’s decision. The appeal was not upheld so our client had no alternative but to pursue a complaint with the Financial Ombudsman Service. Although the complaint took several months to be considered the FOS found in our client’s favour and found that benefits should be reinstated and back pay provided from the date the payments stopped. This amounted to over £100,000.