Case25 - Late Submission - Equity Jurisdiction Late submission of a disability claim. A group policy provided for submission of a claim within three months of the date of disability; the claim was submitted late due to the complex nature of the insured's medical condition; exercise of equity jurisdiction.
Case 13 - Late Submission of Group Scheme Funeral Benefit Claim Policy providing submission by nominee of claim within six months from date of death; late submission due to personal circumstances and policy unknown to nominee; insurer unable to show specific prejudice if claim admitted; exercise of equity jurisdiction
Case 12 - Final Determination Policy providing that claims must be submitted within a stipulated time; complainant given 4 months sick leave to receive treatment; thereafter her condition deteriorated; finally, some nine months after the stipulated time had expired, doctors declared her permanently disabled; Ombudsman’s equity jurisdiction applied.
Case 11- Funeral Policy Funeral Policy – policy term providing for payment to relative if no spouse and no beneficiary – on death of the life insured the insurer paid the ex-spouse – as this was not in accordance with the policy provisions, insurer ordered to pay his mother
Case 10 - Interpretation of income protection policy Interpretation of income protection policy - whether the wording can be interpreted, as contended by complainant, to include automatic benefit increases when complainant in claim - determination by the office in favour of the complainant. (In an appeal by the insurer the Appeal Tribunal upheld the office's determination) (Case 10/2011 - Final Determination)
Case 8 - Late submission of disability claim Late submission of disability claim; complainant dismissed while still able to work and reinstated after he became disabled; application of equity jurisdiction (Case 8/2010 - Final Determination)
Case 6 - Funeral Policy Funeral Policy – interpretation of conditions regarding reinstatement after lapsing (Case 6/2010 - Final Determination)
Case 5 - Funeral benefit claim Funeral benefit claim – repudiation of claim on grounds of late notification. Is this the appropriate case for the Ombudsman to exercise his equity jurisdiction? (Case 5/2010 - Final Determination)