The insurance industry regrettably does not enjoy a particularly good reputation. The main reason is that clients' expectations are not met and insurance policies all too often do not live up to the advertising puff. Unfortunately, intermediaries are often first in the firing line when a client's expectations are not realised.
In a recent claim the intermediary's client brought an action, alleging that the Key Persons section m the cover was not in accordance with what they thought they had bought. The features document stated that Key Persons cover would prance 5250 per week in respect of temporary total disablement up to a maximum of 104 weeks.
One of the two individuals nominated was hospitalised during an illness for a considerable period and believed he had a claim under the policy. It was at that stage that the intermediary had to explain that the cover in respect of temporary total disablement only applied to personal accident. To make matters slightly worse, a claim file was opened because at took some time before it was realised that the hospitalisation was not due to personal accident but rather to illness.
Needless to say, the insurers refused to pay. The client would have been wise to contact the Insurance Ombudsman to complain about the difference between the features document and the actual policy wording.
Instead they brought proceedings m the county court, which they handled themselves. Their specific complaint was that the intermediary had failed to bring to their attention an apparent contradiction in terms between the cover summary and the actual policy document. The intermediary's defence was that the difference had been brought to the attention of the client when the proposal form was completed. The small claims court judge decided there was no ease to answer.
What the case does highlight however is that quite often the advertising puff or summary of cover is not adequate.
It does not clearly state on its face that policyholders should read the actual terms and conditions of the policies which will govern. The ABI Code against which standards will be measured requires intermediaries to explain all the essential provisions of the cover so that the policyholder understands what he is buying.
There are clearly dangers in relying on oral evidence to prove that clients were aware of actual differences between policy summaries and the policies themselves.
It would be better if such advice was given in writing prior to the inception of the policy. Of course, it would he better still if insurance companies made sure that their policy summaries were not misleading. When such instances are found, intermediaries would be well advised to draw them to the attention of the insurance companies.
