Injured rugby player awarded €200,000

AN INSURANCE company has been ordered to pay €200,000 to a former professional rugby player by the Financial Services Ombudsman after it refused to pay out a claim under an insurance scheme run by the Irish Rugby Football Union.

Details of the case were published yesterday by the Financial Services Ombudsman, Joe Meade, who revealed that complaints to his office have risen by almost 30% so far in 2007.

A report by Mr Meade, which highlights more than a dozen cases of questionable practices by banks, insurance companies, credit unions and other financial institutions, recorded about 2,100 complaints since the start of the year.

Although Mr Meade has repeatedly declined to publicly identify parties criticised in his report for legal reasons, he pointed out that he has referred many cases to the Financial Regulator who could publish their names and impose maximum fines of €5 million.

Mr Meade also confirmed that he had asked the Financial Regulator to examine the sales practices of various insurance companies on the basis that he had identified incidents where totally unsuitable policies had been sold.

Overall, about 1,200 cases relate to insurance companies with a further 900 complaints about banks and other credit institutions.

In one case, an unnamed insurance company disputed a claim lodged by a rugby player who suffered a career-ending knee injury in August 2000.

The player was unable to resume playing professionally, despite several attempts before his contact was terminated by the IRFU in 2002.

Consequently, he submitted a claim for permanent total disablement in 2004. However, the insurer challenged the claim on the basis of the injured party’s ability to play amateur rugby . It argued that it had not been given adequate opportunity to medically assess his position because of the late notification of the claim.

The Ombudsman ruled that the IRFU policy only covered people playing in a professional capacity. Mr Meade said the player had only made the claim after he had “genuinely tried as much as was humanly, medically, and indeed, sportingly possible to resume his professional career”.

Hr ordered the insurance company to pay the complainant €190,461 — the full benefit under the policy, while also directing it to pay him an additional €10,000 in compensation for distress and expenses.

In a separate case, the Ombudsman upheld a complaint against an insurance company that refused to meet a claim for €165,000 under a specified illness cover policy.

It argued that the person’s medical condition did not satisfy the policy definition of a heart attack.

Mr Meade said he sought an independent opinion from a cardiologist because of conflicting medical opinions. .

The Ombudsman ruled in favour of the complainant on the basis that he suffered a heart attack “on the balance of probabilities”.

Details of further cases can be found at www. financialombudsman.ie.