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JimLawyer
JimLawyer, Solicitor
Category: Republic of Ireland Law
Satisfied Customers: 13565
Experience:  Senior Associate Solicitor
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I bought critical health insurance in 1996 but when making a

Customer Question

I bought critical health insurance in 1996 but when making a claim in 2019 ,which was refused. I was told that if I wasn’t happy with the policy I had 30 day cooling off period in 1996, which was the first I heard of a cooling off period and the insurance company have no copy of the letter sent to me and I certainly have no records of ever receiving any such letter, what are my rights?
JA: What state are you in? It matters because laws vary by location.
Customer: Certainly I am in the Republic of Ireland
JA: Has anything been filed or reported?
Customer: The insurance company say it was a so called generic letter and can’t find it.
JA: Is there anything else the Expert should know before I connect you? Rest assured that they'll be able to help you.
Customer: We have paid our premium by direct debit and never missed one payment, thanks
Submitted: 11 days ago.
Category: Republic of Ireland Law
Expert:  Virtual-mod replied 11 days ago.
Hello,

I've been working hard to find a Professional to assist you with your question, but sometimes finding the right Professional can take a little longer than expected.

I wonder whether you're ok with continuing to wait for an answer. If you are, please let me know and I will continue my search. If not, feel free to let me know and I will cancel this question for you.

Thank you!
Expert:  JimLawyer replied 11 days ago.

Hello, this is Jim and welcome to JustAnswer. I will be the lawyer working with you today.
Sorry to hear of the issue. I will set out my written answer shortly.

Expert:  JimLawyer replied 11 days ago.

You have protection here given that you are a consumer and there is an Ombudsman to ensure your consumer rights are protected.

You are covered under the Sale and Supply of Goods and Services Act 1982 here which means you have a right to expect a service (from the insurer) carried out with reasonable care and skill. Furthermore, the policy should be “fit for purpose” and “as described”. If it isn’t then you can allege breach of your consumer rights and breach of contract.

You should now make a formal complaint and if that does not resolve the matter ask them for a "deadlock letter", which is a letter giving their final response. Their complaints details will be on their website.

Once you have the deadlock letter the next step would be to escalate this to the Financial Services Ombudsman - they will investigate and liaise with the insurer which would hopefully result in a reinstatement of cover under the policy. They can order the insurer to make a financial award for inconvenience if they have acted poorly.

Once you have their final response, you can make the complaint here : https://www.fspo.ie/make-a-complaint/

Based on the circumstances, assuming the insurer does not uphold your complaint, I am sure the Ombudsman will do. The Ombudsman will look at this case independently and will make a decision based on what happened. Their decision is binding on the insurer. If the Ombudsman did not find in your favour, therefore, you then have the option of suing the insurer for breach of your consumer rights and you have up to 6 years to bring a claim to the court (the limitation period is 6 years from your date of loss, to when you need to issue a claim).

Expert:  JimLawyer replied 11 days ago.

I hope this helps and answers the question - my goal is to ensure you are happy with the answer and have the information you need. If you have any follow up questions then please let me know. I will reply as soon as I can to help with any further queries.

Many thanks,
Jim

Expert:  JimLawyer replied 11 days ago.

Please let me know if the answer helped or if you need me to cover anything else?. I am happy to clarify the answer or if you have any follow up questions. If so, I’d be grateful if you would let me know. I am free most days, including weekends, so feel free to ask me anything you are unsure of.

Best wishes,

Jim

Customer: replied 11 days ago.
Good morning Jim. Thanks for your help. I will ring you on Tuesday if that’s okay. The case is with the Financial services and pension Ombudsman office and I can fill you in and give you all the paperwork. Have a nice weekend. Thanks.
All the best.
Tim.
Expert:  JimLawyer replied 11 days ago.

Hi Tim, I can deal online but not by telephone, sorry - yes, we can continue shortly, many thanks.

Customer: replied 10 days ago.
Hi Jim. Thanks for your email, yes emails are perfect, I will be in touch again over the weekend or start of the week with more details. Thanks
Expert:  JimLawyer replied 10 days ago.

My pleasure, thank you and speak soon.
Jim