The following are case studies of recent complaints made to the CDRS, and the resulting decisions of the independent adjudicators appointed by the Regulatory Authority.
Rejection of a travel insurance claim
Complaint: a firm rejected a travel insurance claim on the grounds that the destination was excluded from the policy.
Finding: the independent adjudicator concluded that the claim should be covered under the terms of the policy. The firm was ordered to compensate the policy-holder for the trip cancelation and for failing to deal with their claim properly.
Non-payment of a premium
Complaint: the complainant moved from Qatar back to her country, where bank instructions prevented her from continuing to pay her premium on an investment product.
Finding: the independent adjudicator found that non-payment of the premium was not the complainant’s fault and ruled that the complainant was entitled to the repayment of all policy payments.
Unaware of a Surrender Penalty
Complaint: the complainant intended to enter into a six-year investment policy. At the last minute, to become eligible for a bonus, the policy advisor recommended a 10-year plan, to which the client agreed. However, the client was not aware of the surrender penalty.
Finding: the independent adjudicator found that the firm had been negligent and failed to treat the customer fairly. The firm was ordered to terminate the 10-year plan without cost or penalty.
“Inflexible” Investment Policy
Complaint: the complainant alleged that he was misled on an investment policy because it was not compatible with Sharia principles and lacked flexibility.
Finding: the independent adjudicator found that these matters had been brought to the customer’s attention and that the customer had signed acknowledgements. The complaint was dismissed.
Congenital Condition Exclusion
Complaint: The complainant sought to cover orthodontic treatment through an employer-provided health insurance policy and sent a pre-authorisation form, signed by her surgeon, to the insurance firm. The firm rejected the claim and refused to pay the costs on the basis that the treatment related to a congenital condition and was excluded under the standard exclusion clauses of her policy.
Finding: the independent adjudicator found that the health insurance policy provided by the complainant’s employer was limited to certain benefits, and excluded orthodontic treatment related to a congenital condition. The complaint was dismissed.