Financial Ombudsman Service determination

An insured alleged that he had suffered the insured event of ‘permanent total loss of use of two limbs’, entitling him to $300,000. We submitted that the fact that the insured could still walk short distances with crutches, albeit with severe pain, meant that he had not suffered ‘permanent total loss of use’ of the lower limbs. The Financial Ombudsman Service accepted this submission and determined in the insurer’s favour.

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