CR181

Disability – Disability cover at an advanced age

Background

The policy provided cover relating to disability arising from an accident. The definition which features in the policy read:-

“Permanent total disablement means disablement which entirely prevents an insured person from carrying out or giving attention to gainful employment of any kind and which is proved by medical evidence to be likely to last for the remainder of the insured person’s lifetime.”

One would normally expect disability contracts to expire at age 60 or 65 but in this case the contract was renewable to age 74.

Discussion

The policyholder sold firewood which he cut using a chainsaw. In August 2004 he fell and fractured his left wrist. An operation was performed and he was left with residual stiffness and significant reduced range of movement of the wrist and of finger flexion together with weakness of his left hand. The policyholder being left-handed alleged that he was unable to undertake the manual work on which he was dependent for his livelihood. The claim was supported by reports from two doctors.

The policyholder contended that he could no longer use a chainsaw and that he would be unable to make a living if he had to employ someone to assist him processing wood for sale.

Although the contract features an “Any Occupation” definition, which is a very wide definition, we had to pose the question what alternative employment could an individual aged 73 pursue? We were not persuaded that he could fill a fanciful post such as a boom operator or doorman which is one often quoted by insurers of this nature. Clearly this was a policy where age was a relevant factor – as was acknowledged by the fact that the insurance company restricted the annual renewal age to 74, recognising that occupational disability at a higher age would present definition difficulties.

The Ombudsman took the view that this was a claim which required a degree of benevolence and should be met.

Result

The insurance company agreed to settle the claim in the complainant’s favour.

DM
November 2006