The following are case studies of recent complaints made to the CDRS, and the resulting decisions of the independent adjudicator appointed by the Regulatory Authority.

Case 1

Mr. A (the “Insured” and “Complainant”) obtained a policy of travel insurance covering loss of or damage to personal baggage during the period of travel.

The Complainant had personal items removed from a vehicle. The insurer rejected the claim on the basis that the complainant failed in their duty of care as the vehicle was left unlocked with the complainant’s personal items left unattended. The insurer’s decision was found without merit as there was deemed to be no failure in the complainant’s duty of care when the vehicle was left unlocked for a short period in full view of the complainant.

Case 2

Mr. A (the “Insured” and “complainant”) obtained a policy of insurance from a QFC Insurance company (the “Insurer”) covering medical fees.

The Insurer decided to refuse the complainant’s request for medical expenses based on a pre-existing condition. The insurer relied upon medical records prior to the commencement of the policy which evidence a medical condition in the same area.

The decision was overruled because there was nothing in the evidence submitted that suggested the complainant should have reasonably known about the particular medical condition or its symptoms prior to the inception of the policy. The complainant could have only known about the condition after the policy commenced.

Case 3

Mr. A (the “Insured” and “complainant”) obtained an investment policy from a QFC Insurance company (the “Insurer”). The complainant sought to either reinstate the policy or receive a refund of the total sum contributed towards the policy. The policy required that the complainant make this request by a specified date, the complainant failed to do this due to the unforeseen circumstances of the Covid-19 global pandemic.

The Insurer decided to refuse to either reinstate the policy or refund the monies as the request was received after the notification period.

The decision was overruled due to the existence of a force majeure event, the insurer was required to reimburse the complainant the full amount contributed towards the policy.