Having recently concluded a case with the FSO where I was unsuccessful I thought it may be useful to share some salient points. Anyone appealing to the FSO should bear in mind that it is not a "pro-consumer" agency. Its role is to adjudicate in disputes.
A financial service provider applied what I contended was an unwarranted exclusion on a policy for which I had proposed.
1. I had requested information under the Data Protection Acts from the financial service provider so that I could better understand the decision, as the provider's policy allowed for an appeal if you were unhappy with the policy terms. I believed that the provider had failed to deliver all of the information. The provider, a large international financial service group, contended that its underwriting department and medical advisers did not as part of their standard practices use email when discussing cases and therefore no emails existed relating to my case. This was later contradicted when the provider sent a copy of an internal email with my details to the FSO and the FSO released this to me. So, it seemed reasonable to assume that some emails existed and it was a fact that if these emails existed they had not been released to me by the provider. However, the FSO ruled that it would not entertain matters relating to the non-release of data (data protection elements) and this was despite the data protection elements being central because I needed this information to support my case.
2. The adjudication from the FSO contained a number of errors of fact: simple things and not hugely pivotal but sufficient to undermine confidence that the documentation for the case, which was hugely extensive, had not received due diligence. A request to the FSO for clarification of its checking procedures, and for information about how many people had examined the case, if there was any internal documentation about the case or dissenting opinions was met with a curt response which informed that the case was closed and an appeal to the high court was the only thing I could now do.
3. The case revolved around an interpretation of a medical consultant's letter. Despite that consultant's boss writing to contradict the inference drawn from the letter, the FSO found that the provider was entitled to interpret as it saw fit and the FSO confirmed to me that in the case of medical testimony it had no role and would not adjudicate on what a medical professional had written, regardless of how right or wrong it appeared to be.
4. It came to light during the case that the provider's medical personnel appear to not view an applicant's full medical information. Instead, the provider has someone create a short, in this case one-page, document which summarises the (possibly hundreds but certainly dozens) of pages of medical information about you and then the provider's medical officer looks at the one-pager. The FSO was of the view that no bad faith could be found and that the provider had followed its own procedures, despite my contention that due care had not been exercised in considering all of the medical information.
Overall, it was a very interesting case and I learned much from it, with the main lesson being that I would not rely on the FSO to "be on the side of the little person".
A financial service provider applied what I contended was an unwarranted exclusion on a policy for which I had proposed.
1. I had requested information under the Data Protection Acts from the financial service provider so that I could better understand the decision, as the provider's policy allowed for an appeal if you were unhappy with the policy terms. I believed that the provider had failed to deliver all of the information. The provider, a large international financial service group, contended that its underwriting department and medical advisers did not as part of their standard practices use email when discussing cases and therefore no emails existed relating to my case. This was later contradicted when the provider sent a copy of an internal email with my details to the FSO and the FSO released this to me. So, it seemed reasonable to assume that some emails existed and it was a fact that if these emails existed they had not been released to me by the provider. However, the FSO ruled that it would not entertain matters relating to the non-release of data (data protection elements) and this was despite the data protection elements being central because I needed this information to support my case.
2. The adjudication from the FSO contained a number of errors of fact: simple things and not hugely pivotal but sufficient to undermine confidence that the documentation for the case, which was hugely extensive, had not received due diligence. A request to the FSO for clarification of its checking procedures, and for information about how many people had examined the case, if there was any internal documentation about the case or dissenting opinions was met with a curt response which informed that the case was closed and an appeal to the high court was the only thing I could now do.
3. The case revolved around an interpretation of a medical consultant's letter. Despite that consultant's boss writing to contradict the inference drawn from the letter, the FSO found that the provider was entitled to interpret as it saw fit and the FSO confirmed to me that in the case of medical testimony it had no role and would not adjudicate on what a medical professional had written, regardless of how right or wrong it appeared to be.
4. It came to light during the case that the provider's medical personnel appear to not view an applicant's full medical information. Instead, the provider has someone create a short, in this case one-page, document which summarises the (possibly hundreds but certainly dozens) of pages of medical information about you and then the provider's medical officer looks at the one-pager. The FSO was of the view that no bad faith could be found and that the provider had followed its own procedures, despite my contention that due care had not been exercised in considering all of the medical information.
Overall, it was a very interesting case and I learned much from it, with the main lesson being that I would not rely on the FSO to "be on the side of the little person".
