Someone must be responsible

Alice had life and health insurance through her employer. In January 2022 Alice received a letter from her insurer advising that the method of paying for her insurance had changed and, instead of a deduction from her wages, Alice would need to set up a direct debit to pay for her insurance. The insurer also advised that Alice’s premium was doubling.

At around the same time, Alice also received an email from her insurance adviser saying that he was aware of the changes and inviting Alice to contact him to discuss her options.

Alice was shocked. She could not afford the premium increase and was being given less than a month to decide what to do about her insurance. The adviser suggested Alice increase the excess, which would decrease the premiums. Alice said these premiums were still too high and that she felt she had no option but to cancel the policy. The adviser urged caution, suggesting that Alice accept the insurer’s offer so that she would maintain cover for existing medical conditions while he looked for alternatives.

Alice considered her options and cancelled the insurance.

Alice complained to the adviser that he should have told her earlier about the changes. The adviser explained that although he knew the payment method was changing, he did not know about the premium increase. Alice did not accept the adviser’s response and complained to FSCL.

Dispute

Alice complained that the adviser had known about these changes for six months but had done nothing to communicate with her, her employer, or the union who supported Alice in her relationship with her employer. Alice said that if she had been given more warning, she would have asked the union or her employer to do something to stop the premium increase.

The adviser agreed that he had known the payment method was changing and had been communicating with the insurer, the employer, and the union for months. The adviser said he thought there would be some change to the premium but had no idea the premium would double. The adviser provided his email correspondence with the employer, the union, and the insurer. The adviser had been trying to organise a co-ordinated response to the insured people, but the insurer was either ignoring his requests for information or promising a response that never came.

Review

We contacted Alice and discussed the adviser’s response to her complaint. We explained that even if the adviser had contacted her earlier, the most he could have said was that the way she was paying for her insurance was changing and there may also be an increased premium. We considered it was unlikely, if Alice had been given this advice, that she would have complained at this point. Even if Alice had queried her employer and the union earlier, she would not have discovered the premium increase because this information was not available until the insurer wrote to all the insured people.

We also said that it seemed to us that the adviser had done everything he could do once he learned of the premium increase. It was the insurer’s decision to increase the premium and it was Alice’s decision that, even by increasing the excess to reduce the premium, the insurance was unaffordable for her.

Resolution

Alice agreed to discontinue her complaint about the adviser and said that she was complaining to the Insurance and Financial Services Ombudsman about the insurer’s actions.

Insights for participants

Underlying this complaint was Alice’s feeling that it was fundamentally unfair that her insurance premiums had increased so considerably leaving her with, in her view, no option but to cancel the insurance policy she had held for many years that covered her existing medical conditions. Alice felt someone was to blame and turned initially to her insurance adviser.

We were able to look at the adviser’s records of extensive conversations and emails with all the parties involved and explain to Alice that, in our view, he had done all that could be reasonably expected of him. Our independent viewpoint allowed Alice to let go of the complaint about the adviser and focus her attention on the insurer.