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  1. Point in time
    2012-12-30

DISP App 3.5 Re-assessing rejected claims

DISP App 3.5.1ERP

Where a complaint is about the sale of a policy, the firm should, as part of its investigation of the complaint, determine whether any claim on that policy was rejected, and if so, whether the complainant may have reasonably expected that the claim would have been paid.

DISP App 3.5.2GRP

For example, the complainant may have reasonably expected that the claim would have been paid where the firm failed to disclose appropriately an exclusion or limitation later relied on by the insurer to reject the claim and it should have been clear to the firm that that exclusion or limitation was relevant to the complainant.