Insurance policies still confuse many Ombudsman notes 'careful consideration' needed

The Insurance Ombudsman's Office dealt with 1,648 written complaints in 2003, and the bulk of the cases were concluded during the year, according to the 2003 report from the office, published yesterday.

The most frequent areas for dispute were in life assurance, motor, pension, permanent health and travel insurance. The report included a number of case studies, some of which are summarised in the accompanying panels.

The Ombudsman, Ms Caroline Gill, said complaints upheld during the year ranged in value from a few hundred euro up to the limit for her office, which is €160,000.

The decisions of her office are binding on the companies that are part of the ombudsman scheme.

As well as written complaints, the office dealt with 10,517 phone calls during 2003. The average time taken to adjudicate on a complaint was four and a half months.

Ms Gill said her office had received 814 complaints so far this year.

Of the caseload in hand, 97 were current year complaints.

She said the general issues which emerged during 2003 included persons who were not clearly aware that insurance is usually for specified events. "Policyholders should give careful consideration to the terms of their policy documents in order to ascertain the extent of the cover offered, " she said.

She also said that the principal characteristic of an insurance contract is that the parties to it are operating in good faith.

Her report gives a number of examples of people who did not give full information to the insurer.

She said that during the year she had noticed an increased use of loss assessors and engineers by complainants in pursuing household insurance claims.

"Policyholders should remember that such professional fees are generally not included within the terms of cover but are payable by the policyholder."

People who decided not to travel to areas affected by SARS sought compensation under travel insurance. However, their complaints were not upheld.