Case Studies

Our case notes show how we deal with the many different issues that arise in our case investigations. The case notes aim to provide consumers and participants with guidance as to the approach we are likely to take in a particular type of case or highlight some of the many different ways in which a complaint can be resolved.

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Title Year Case summary
‘Relative’ is a relative term 2017

A couple cancels their travel plans because of a death in the family. The insurer denies their claim for cancellation costs, saying the couple isn’t covered for the death of any person aged 85 or over. Should the couple have been told about the exclusion?

You’re my adviser! You should be advising 2017

Christine asked an insurance adviser to place cover to protect her family in the event she got sick. When Christine’s subsequent sickness was not covered by insurance, Christine complained to FSCL.

A declined lump claim lumps Catherine with a big vet bill 2017

Catherine’s pet insurer declines her claim for her dog’s chin lump based on an exclusion clause endorsed on the policy for an unrelated pre-existing lump. Has the insurer declined the claim correctly?

How long is too long to repair a flooded building? 2016

Following a flood in June 2015, it takes 10 months for repairs to be completed. Did Bert’s insurer cause unnecessary delays in effecting those repairs?

Zero communication about zero-rated deferment periods. 2017

Marian claims on her business interruption policy when a power outage affects her business. After her claim is declined, FSCL investigates whether Marian’s broker contributed to her loss.

“A traumatic trauma claim” 2016

In 2015 Hans has a trauma claim paid after he suffered strokes. However, Hans considered he could have received further benefits under his policy if his adviser had provided him better advice. Was the advice process flawed, causing Hans a financial loss?

“I’ve gotta get out of this place, if it’s the last thing I ever do.” 2016

Jack injures his knee in Cambodia and suffers complications after surgery. Does Jack’s travel insurer have to pay him $30,000 in damages?

“Can I claim for costs when I’m forced (by logistics) to continue my holiday?” 2017

Mary was injured on a day excursion during her cruise. Because of the cruise’s itinerary Mary was unable to return home until five days after the injury occurred. Is Mary able to claim ‘cancellation costs’ from the time of the injury because she couldn’t enjoy the cruise as she had envisioned?

“I just want my complaint resolved! I don’t care who resolves it” 2017

Holly switched motor vehicle insurers at her broker’s insistence. She made it clear that she wanted to continue ‘agreed pay out’ insurance with her new insurer. When Holly crashed her car, she found she only had ‘market value cover.’ Does Holly have recourse against the broker for this error?

Deep fat fryer fire 2017

What happens when a fish and chip shop deep fat fryer catches fire because it has not been properly serviced and maintained, in breach of the insured’s obligations to the insurer?