Judge strikes out case — but urges insurer to reconsider paying out

A High Court judge issued a “heartfelt plea” to an insurance company to re-consider the plight of a man refused payment under his serious illness policy because he underwent surgery on one, rather than two, arteries as required by the policy.

Mr Justice Gerard Hogan said the law obliged him to strike out an action by Florence Crowley against Zurich Life Assurance plc but he had “considerable sympathy” for Mr Crowley.

The man was “doubly disadvantaged” having clearly suffered a serious illness which greatly diminished his earning capacity, he said.

It gave him “no pleasure at all” to find Mr Crowley’s case against Zurich must be struck out due to Mr Crowley’s failure to appeal to the High Court against a decision of the Financial Services Ombudsman (FSO) dismissing his complaint.

“I would request Zurich to give as sympathetic a re-consideration of the underlying merits of this claim as it considered feasible,” he said.

Barney Quirke, for Zurich, sought time to consider the judgment and the matter was adjourned to April 22.

Mr Crowley underwent surgery in 2010 for a serious heart condition. The surgery involved an angioplasty stenting of the lower anterior descending (LAD) artery.

Zurich said because he underwent surgery to correct narrowing of one artery only, he was not entitled to serious illness benefit.

Mr Crowley complained to the FSO, which ruled the policy definition required two or more arteries to be stented.

There was no objective evidence to show Mr Crowley’s treating doctors did not insert a stent on one of his other arteries (as opposed to a branch of the LAD) because there was a preferable course of treatment available or such course of action may have placed his life in danger, the FSO added.

Mr Crowley did not appeal the FSO decision but, representing himself, initiated High Court proceedings against Zurich and the FSO. His case against the FSO was previously struck out because no action against the ombudsman may be brought unless bad faith is shown and there was no evidence of bad faith in this case.


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