Financial Ombudsman Service
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The Financial Ombudsman Service (“FOS”) is stated to be ‘The official independent expert in settling complaints between consumers and businesses providing financial services.’ It is a public body that was established by Parliament and is authorised to deal with a very broad range of complaints in areas ranging from banking and insurance, to loans, credit and hire purchase and savings and investments. The standard it applies when determining complaints, is what in the opinion of the ombudsman is fair and reasonable in all the circumstances of the case ; with the ability to award ‘fair’ compensation for loss or damage. Indeed, the FOS has come to enjoy a considerable reputation due to its efficiency, independence, and impartiality when dealing with complaints, dealing with almost a million enquiries, settling over 150,000 disputes a year, and settling a third of cases within three months. In fact, in the latest six-monthly (between 1st January and 30th June 2010) complaints data released on individual financial businesses, the FOS received 84,212 new complaints and upheld an average of 44% of complaints in favour of consumers.
The FOS has therefore demonstrated a strong complaints-handling performance with cases usually settled informally. Moreover, consumers are still free to reject a FOS decision and take their case to court instead if they so wish. Given such credentials, it might seem to be the case that consumers having complaints relating to insurance are well protected under the FOS regime. However, it is submitted that the draft Consumer Insurance (Disclosure & Representations) Bill (the “Bill”) recommended by the Law Commission (“LC”) is of significant practical benefit to consumers, and brings a great deal to the table in relation to insurance contracts. In fact, if enacted the Bill would represent a watershed in the law governing disclosure and representation in consumer insurance contracts. Inherent difficulties stem from the fact that this area of law is governed by archaic legislation in the form of the Marine Insurance Act 1906 (“MIA 1906”). The main difficulty is that the MIA 1906 stipulates that ‘A contract of marine insurance is a contract based upon the utmost good faith, and, if the utmost good faith be not observed by either party, the contract may be avoided by the other party.’
In fact, this principle of utmost good faith or ‘uberrimae fidei’ is of antiquated origin and imposes very strict disclosure requirements on the part of the assured to an insurance contract. Thus, the assured must disclose ‘every material circumstance which is known to the assured’ , with the assured being ‘deemed to know every circumstance which, in the ordinary course of business, ought to be known by him.’ Furthermore, material circumstance is expounded as including ‘Every circumstance is material which would influence the judgement of a prudent insurer in fixing the premium, or determining whether he will take the risk.’ The relevant test was elucidated upon further in Pan Atlantic Insurance Co Ltd & Another v Pine Top Insurance Co Ltd where the House of Lords held that the test of materiality of disclosure required any relevant circumstance to have had an effect on the mind of a prudent insurer in weighing up the risk, i.e. objective in nature. However, a certain degree of subjectivity was also attached to the test in that it was also held that an insurer would only be entitled to avoid an insurance policy if the material non-disclosure or misrepresentation had actually induced the making of the policy. Finally, every material representation made by the assured or his agent to the insurer prior to the making of a contract must be true or the insurer may also avoid the contract, even for honest mistakes leading to untrue material representations.
Consequently, if the assured fails to disclose all such material information the insurer may avoid the contract and refuse to pay out for any claim under the insurance contract. Thus, whilst this strict duty of disclosure may have been pertinent for commercial merchants at the turn of the twentieth century, it is difficult to justify the policy behind its continuation into a twenty-first century replete with a plethora of insurance contracts taken up by ordinary lay consumers. Its often harsh and unfair effects are exemplified by the case of Lambert v Co-operative Insurance Society Ltd. In Lambert, the Court of Appeal held that an insurer was entitled to avoid an insured’s policy on the basis that the insured had failed to inform the insurers that her husband held previous convictions, even though she had not been asked this. Nevertheless, the convictions were held to constitute material circumstances which should have been notified to the insurers under the ‘prudent insurer’ standard. Even whilst acknowledging the point in law proved by the defendants, the judge professed that they would be acting decently if they were to pay her nonetheless, even adding that ‘It might be thought a heartless thing if they did not, but that is their business, not mine.’
Even in 1975 one can see the excessive nature of the uberrimae fidei standard acting to the detriment of the innocent party. It is one thing for Parliament to set out insurance requirements precluding any misrepresentation at a time when the insurance market was in its infancy (following the Lloyd’s Act, 1871); it is quite another to continue to impose such draconian standards on millions of ordinary consumers a century later. Indeed, as recognised by the LC: ‘We think the time has now come to update the law to meet the needs of a different century’ ; with it identifying five main problems with the existing law. Firstly, it found that consumers were only able to obtain justice from the FOS and not from the courts, as the courts were forced to apply the unfair rules. Moreover, the LC stated that the compulsory jurisdiction of the FOS was limited to awards of ?100,000. This effectively sets a dual standard depending on whether the consumer is rich or not, with those individuals insured for figures in excess of ?100,000 (e.g. buildings or life insurance) forced to take their chances in courts with much stricter standards. The LC noted the FOS would decline to hear cases which required cross-examination of witnesses, so cases venturing into complex areas or involving third parties again ostracised consumers.
Secondly, the LC considered the current rules were ‘unacceptably confused’, with many consumers not realising a right to complain to the FOS, and with the ‘resulting muddle leading to a loss of confidence in the insurance industry’. Thirdly, the LC believed the legal system penalised some vulnerable groups and cited problems experienced by older individuals, those with criminal convictions , or even those with Multiple Sclerosis (owing to early but undiagnosed symptoms leading to a rejection of critical illness insurance claims). Fourthly, the LC believed the system imposed an inappropriate role on regulators, as the FOS and Financial Services Authority were forced to effectively act as policy and rule-makers. Additionally, the courts were systematically forced to reach unfair decisions. Finally, in the face of across-the-board European Union harmonisation, it stated that it was ‘difficult to justify the present incoherent layers of law to an international audience.’
The LC’s recommendation for reform of the onerous legal position ‘in which the strict letter of the law had been overlain by successive layers of self-regulation, FSA rules and FOS guidelines’ , took the form of the recommended enactment of the Bill. Under the Bill, a consumer insurance contract (“CIC”) is defined as one entered into ‘…by an individual wholly or mainly for purposes unrelated to the individual’s trade, business or profession’. The Bill replaces the duty of utmost good faith by instead stipulating that: ‘It is the duty of the consumer to take reasonable care not to make a misrepresentation to the insurer’ in any disclosures or representations made by the consumer to an insurer prior to entering into, or varying, a CIC. ‘Reasonable care’ is said to be determinable ‘…in the light of all the relevant circumstances.’ This includes things such as ‘the type of consumer insurance policy in question, and its target market’ ; the insured’s produced or authorised explanatory materials or publicity ; the clarity and specificity of the insurer’s questions ; and ‘whether or not an agent was acting for the consumer.’ Also the Bill, prevents contracting out of these obligations by putting the consumer in a worse position , or the use of ‘basis of the contract’ clauses, namely clauses which convert consumer representations into warranties, breach of which automatically terminates insurance cover.
The Bill also provides for balanced insurers’ remedies for different types of misrepresentations. For example, an honest and reasonable misrepresentation by the assured does not affect the validity of the insurance contract whereas a deliberate or reckless qualifying misrepresentation allows the insurer to avoid the contract, refuse any claim and keep any premiums paid (unless good reasons exist why they should not be kept). However, the insurer’s remedies for any careless representations are based on what the insurer would have done if the consumer had complied with the reasonable care duty. This ranges from avoiding the contract to proportionate reduction of a claim (because the insurer would have charged a higher premium). Although widely accepted, the proposed reforms are not without criticism. For example Soyer has argued that the reasonable assured test for materiality is nebulous and has not been previously tested; that the availability of ‘proportionate’ remedies may lead to uncertainty as well as being open to criticism from theoretical and economic perspectives; and that statutory control is not practical and undesirable.
Nevertheless, it is submitted that such criticisms are weak in the face of the currently manifestly unfair application of dated insurance law principles which are adversely affecting consumers. The law is clearly in need of reform and the proposals set out in the Bill clearly represent a fairer, more balanced and transparent process relating to consumer insurance contracts. Butcher has even suggested that ‘…to talk of insurance contracts as being contracts of good faith tends to be either useless or positively harmful to a coherent development of the law.’ He considers good faith to be a redundant concept, with rules now in place which have gone a good deal further than necessary to maintain good faith relations, and which have provided insurers with a weapon which produces the opposite results of what good faith would demand. Whilst it is true that the service provided by the FOS is currently invaluable to thousands of insurance consumers across the UK, it cannot be a viable substitute for properly focused and balanced reforms. The Bill achieves this and it is submitted there is no reason to delay its enactment.
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