Albert came to us with a most interesting experience. His is a tale which spanned years in the making, with equal parts of hope and disappointment.
He shared his encounter of bringing his case up to the Financial Disputes Resolution Centre (FIDReC), which is an independent (quasi-legal) body which specializes in handling financial contract disputes. Think of it as the financial industry equivalent of CASE.
Here is his story.
The details of the case, as well as the parties involved, are all required to be kept in strictest confidence. This is to preserve the judicial integrity of the work that FIDReC provides. As such, all names, companies, and other information directly linked to the case will not be divulged.
The timings, dates, and relevant periods have also been altered.
I bought a policy years ago during a roadshow. At that time, it seemed like a fantastic deal and I made my decision to purchase on the spot.
Due to the hurried nature of the sale, I glossed over one particular declaration inside the proposal form, thinking that it would probably be inconsequential. When I checked with the person selling me the policy, she too agreed that the declaration need not be made, so as to incept the policy as quickly as possible.
They say insurance is meant to cover small probability events with big consequences, but later I found out that was untrue, at least for me. Why?
When I met with a minor bicycle accident late in 2014, it was precaution that sent me to the hospital for a CAT scan. That’s when I found out there was a tumour growing in my head.
Big consequences for me? No doubt.
Small probability? When it happens to you, you will never think it is small enough.
Luckily for me, the surgery was a success. Then I remembered that I could claim from my policy.
It all went downhill from there.
Things left unsaid, are construed as lies
My claim for critical illness was rejected. You guessed it, it was the omission in paperwork that led to that decision.
I was raging deep within. I paid my premiums dutifully for years. I was induced to sign the contract without fully understanding the implications of my non-disclosure.
Yet, essentially the claim was rejected because they felt I was untruthful at the point of purchase.
The fight begins
I refused the offer of rescinding the contact and receiving my premiums back. To me, I was entitled to my claims since I held up my end of the deal.
After weeks of unsatisfactory replies from the company, I was offered the chance to bring the case up to FIDReC. It was a no brainer – of course I’ll fight!
There was still attempts at mediation (where both parties could come to a mutual agreement through negotiation), but the company stood their ground, so did I.
Adjudication as my last hope
I was informed that it would then be up to an adjudicator (or a panel of people) to run through my case details, and give a ruling. Technically I could continue to pursue the matter even if Adjudication did not work in my favor. But given the potential cost of legal fees, and not to mention the effort required, it would be foolhardy to continue.
I was given a time and date to turn up and explain my case.
Not quite what I had in mind
The day came soon enough. I had mentally rehearsed my story. I had run through all my paperwork umpteen times. I had imagined the entire process to be a solemn encounter – just think of all the law films you have ever watched, featuring the judge and the jury and the lawyers!
I was brought into a room around the size of a class room, with tables and chairs to seat half a dozen people. I was half expecting the adjudicator to be wearing a wig, monocles, and a stern expression. (It was my first experience)
When he walked in from his chamber, I was totally surprised. Not quite what I had in mind.
Gentle and Genial
He was an elderly gentleman who was obviously well versed in Law. But he spoke with an air of casualness, like one who would, while commenting on the weather. Yet we were discussing the outcome of a contract worth many thousands of dollars.
The banter began so naturally, I did not even notice when we started to discuss the case at length.
He asked me if I had anything to say, so I re-stated my claims and why they should be valid. Throughout my recollection, he was nodding and in obvious agreement with me – surely that bode well for my case!
He then asked the company representative if he had anything to add, to which little was said.
The Adjudicator then proceeded to call in a witness for the case, which was, in fact the person who sold me the policy.
Selective Amnesia? Or total Denial?
She obviously forgot who I was. That much was obvious given the blank look on her face. Probably sold to thousands and thousands of clients, and I was just a face in the crowd to her.
The adjudicator asked if she could recall any details of this case, to which she shook her head.
Then he asked what is her usual mode of closing a sale, and it was at this point I realized that I was not the only one who came prepared. She rattled a whole long list of points, checks, and procedures that she would follow – basically all the right stuff.
I was then given an opportunity to cross-examine the witness. Heck, I never saw that coming! The only question I could think of then was: Do you really care about the welfare of all your customers, or are you just concerned about the sale?
“I care for all my customers” was her bald reply.
At that point, blood was rushing to my temples and my pulse quickened.
“Since you care so much about your customers, why then have I not received a single follow-up call from you after the sale?”
The uncomfortable silence that followed was the answer I needed.
Caught with her hand in the cookie jar – again
If that wasn’t damning enough, the adjudicator’s next question cast her integrity to the point of no return.
“Do you ever fill in forms for your customers? Who fills in the forms?”
She blurted out that she would never, ever, fill in any forms for her customers and that she always made her clients fill in the forms themselves. (Yeah, right)
To which I then offered the option of bringing in a hand-writing analyst ( Ed: technically called a Graphologist) to see if the handwriting on the forms belonged to me or her. I am a messy person by nature, and the forms were all written way too neatly to even resemble my handwriting.
Again, silence ensued. It was thick. It was heavy. But it was like music to my ears. I was winning my case. I was winning this fight!
I was winning my case. I was winning this fight!
Brought down to earth with a crash
After the adjudicator sent the witness out, I was feeling jubilant.
Until he pointed out one key fact.
That I had signed the documents.
I may have been misled, missold, induced, or fell prey to a persuasive sales person – but still, I was the person who signed on the dotted line.
That signature meant that I had to bear the responsibility. Because ultimately I made that decision.
That that point, the adjudication was over and he walked out, saying the outcome would follow in a month’s time.
If I could do it all over again
I have nothing against insurance. On the contrary, I believe it to be crucial for everyone. My surgery was paid for by insurance, so that spared me a great deal of financial pain.
But my only regret was that I didn’t understand the implications of the paperwork I was signing, and jumped headlong into it. Had I a clearer picture of how claims work, I would have never taken a shortcut in the first place.
I would like to caution everyone (and probably myself, most of all) that details do matter. Afterall, there are many thousands of dollars at stake. From this experience, I have learned to comb the fine print and understand each clause before ever committing myself to a contract.
I just wish I had done so years ago. The delay of days or even weeks, for policy inception is nothing compared to the long drawn claims battle that took place for me. All because I hankered after convenience.
We thank Albert for being forthcoming and sharing his story with us. The result of his adjudication is still being processed, and ultimately we may or may not publish it.
The objective of relating this experience is to let our readers understand the adjudication process a little better, and also to highlight the work that FIDReC does. To many of us, it is a good way to resolve Financial Disputes in a quick (and cost-effective) manner.
Far too few of us know of its existence.
Key Things to know about FIDReC
- The limits of adjudication are up to $100,000.00 in the case of a dispute involving insured persons and insurance companies.
- In all other cases, the limit is $50,000.00.
- If the complainant accepts the adjudication ruling, then the Financial Institute must abide by the ruling. The reverse does not apply. So the complainant does have the flexibility of choice.
- The cost of each adjudication hearing is $50.00 (subject to GST) for every claim made. This is far cheaper than going to the courts or engaging a lawyer!
- There will be attempts to mediate an acceptable outcome before adjudication. If the claimant is still not satisfied after all attempts and rulings, he may pursue further legal action.
Read more about FIDReC here.
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