The Original Holloway Friendly Society Limited · DRN-5983478

The complaint Mr B is unhappy with how a claim on his income protection policy was handled by The Original Holloway Friendly Society Limited. What happened Mr B took out an income protection policy underwritten by The Original Holloway Friendly Society Limited. The policy started in July 2024. When the policy was taken out Mr B disclosed various symptoms and previous conditions including reflux problems, ear infection, covid 19 (and how this affected his sinuses and sleep). He also informed Hollow Friendly he suffered from low testosterone. In December 2024 Mr B became absent from work due to stress, so he submitted a claim to Holloway Friendly. They declined cover because his policy didn’t provide a benefit for absence caused by stress. Holloway Friendly also cancelled Mr B’s policy and refunded his premiums. They said this was because he hadn’t disclosed some of his medical history when he took the policy out. Mr B referred the matter to our service. Our investigator looked at what had happened and agreed the claim had been fairly declined because stress wasn’t covered by Mr B’s policy. But he said Mr B had taken reasonable care to disclose all his relevant medical history, so Holloway Friendly should reinstate the policy that had been cancelled unfairly and pay Mr B £150 compensation. Holloway Friendly asked for the case to escalated to an ombudsman. In summary they said: • They disagreed with the investigator’s conclusion in relation to wrist and finger pain • Mr B’s General Practitioner (GP) didn’t say Mr B’s wrist and finger pain was simply a withdrawal side effect. The evidence shows the possibility of carpal tunnel syndrome (CTS) was being considered. • A consumer who reports wrist and finger pain to their GP, and was advised their symptoms might be CTS, could not reasonably dismiss the symptoms as minor or irrelevant. • NHS guidance refers to general muscle aches and flu-like withdrawal effects, not isolated, one-sided pain in the wrist and fingers. • By failing to disclose the symptoms he was actively discussing with his GP, Mr B didn’t exercise reasonable care. Holloway Friendly provided additional evidence to show if Mr B had disclosed a recent history of wrist and finger pain, they would have applied the following exclusion to his policy: “any disease, disorder or injury to either or both wrists and hands including arthritis”

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So the case was passed to me to make a decision. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. The claim outcome The relevant insurance industry rules say an insurer must handle claims promptly and fairly and not unreasonably reject cover. Holloway Friendly declined cover for Mr B’s claim because the cause of his absence was due to stress, and they consider stress to be a reaction to circumstances or surroundings rather than a medical condition. I don’t think this was unreasonable given Mr B said his absence was due to problems with his mother’s health and needing to visit her outside of the UK. I can understand why the distance between Mr B and his family during such a difficult time would have been stressful for him and I appreciate why he may not have been able to work during this time. But this type of absence just isn’t something his income protection policy provides cover for. I can see Holloway Friendly explained to Mr B at the earliest opportunity that stress wasn’t something the policy was likely to cover. But they still obtained the relevant medical evidence they needed to order to look into the claim further, before making a formal decision to decline cover. I think this was reasonable in the circumstances. Based on the above, I think Holloway Friendly fairly declined Mr B’s claim. The cancellation of the policy The relevant law that applies here is The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA). This requires consumers to take reasonable care not to make a misrepresentation when taking out an insurance policy. The standard of care is that of a reasonable consumer. The onus is on The Original Holloway Friendly Society to ask clear and specific questions during the application, and Mr B is responsible for taking reasonable care in answering those questions accurately. Holloway Friendly originally said Mr B failed to take reasonable care when he didn’t disclose the following conditions when he applied for the policy: • Pain in his wrist and finger whilst reducing his prescribed medication • Fatigue, poor sleep and low mood linked to low testosterone • Sinusitis problems They said had they known about the above symptoms they would never have offered the policy to Mr B. So I’ve considered the questions Mr B was asked during the application and the answers he gave.

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Mr B was asked: “In the last 5 years have you had any of these? … Arthritis, gout or anything else affecting your bones, joints, ligaments, tendons or muscles.” He answered “no” to this question, but Holloway Friendly said he should have answered “yes”. Their opinion is based on one GP record on 6 December 2023 that said: “Telephone encounter some side effects since reducing to 1 tab/0.5tab alternating days Advised to stretch out to 1 tab at night for 2 nights then half tab and take things slower Getting some wrist and finger pain since reducing AMT. Advised to see if persists and if ongoing for rv as could be CTS. Might try wrist splint in the interim” The purpose of Mr B’s contact with his GP was to report side effects of reducing his medication, not because he had unexplained pain in wrist and finger. He refers to the pain being “since” he reduced his medication, so I think it was reasonable for him to conclude his medication change was the cause of the pain, rather than it being a symptom of a condition that he needed to disclose. The NHS website references the side effects of reducing this medication as “flu-like symptoms like feeling sick, muscle pain and feeling tired or restless”. Which is in line with what Mr B reported to his GP. Holloway Friendly raised concerns that Mr B only had one sided isolated finger and wrist pain, rather than generalised muscle pain. But I don’t think that makes a difference. I’m not persuaded the reference to muscle pain excludes isolated pain. So I don’t think a reasonable consumer would have answered this question differently to Mr B in the circumstances. I note Holloway Friendly’s comments around the reference to CTS in this evidence. However, I’m not persuaded Mr B was advised he could have CTS. I think the evidence is clear that CTS was only going to be considered, if the pain persisted. So I think it was unreasonable for Holloway Friendly to conclude CTS was being considered. I can’t see any further mention in Mr B’s medical records that he ever suffered from any further pain in his finger or wrist. This further persuades me that Mr B’s one off reference to hand pain as a side effect of changing medication, isn’t something Holloway Friendly should reasonably have expected him to have disclosed. For completeness I’ve also considered the sinusitis problems and persistent tiredness Holloway Friendly said Mr B should’ve disclosed. I’ve haven’t seen any question on the application where Mr B should have declared a sinusitis problem. I’m also mindful that he sent an email to Holloway Friendly following his application to declare he had been off work with Covid 19 and which had affected his sinuses and sleep. Holloway Friendly responded to confirm this would have no impact on his policy terms. So I don’t think it’s fair for them to conclude he didn’t take reasonable care to disclose this symptom. Holloway Friendly appeared to accept this position when Mr B reminded them of the email he had sent, but they said he still should have disclosed his persistent tiredness and fatigue. Mr B was asked: “In the last 5 years have you had any of these? Chronic fatigue syndrome, ME, fibromyalgia or persistent tiredness”

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He answered “no” to this question, but Holloway friendly said he should have answered “yes”. Their opinion is based on one record from 11 July 2023 that says: “Over the past couple of years, he has reported worsening symptoms of low testosterone. Such as weakness, poor recovery from exercise, weight gain, lack of drive and motivation, anergia, fatigue, poor sleep, low mood, loss of libido, erectile dysfunction” I think this evidence shows Mr B’s symptoms of fatigue, poor sleep and low mood symptoms was being caused by his low testosterone levels. Mr B had already disclosed he suffered from low testosterone during the application, so I don’t think there is anything further he reasonably needed to disclose about this. Taking all of the above into account, I don’t think the cancellation of the policy was a fair remedy for Holloway Friendly to have taken under CIDRA. I’m also not persuaded its reasonable for them to add an exclusion for finger pain to Mr B’s policy. Compensation Mr B has explained that the cancellation of his policy had an impact on him at an already difficult time due to his mother being unwell overseas and already being absent from work under stress. So I think £150 is fair compensation to recognise the additional stress and inconvenience Holloway Friendly caused to Mr B when they unfairly cancelled his policy. Putting things right The Original Holloway Friendly Society Limited need to put things right by: • Reinstating Mr B’s policy without the exclusion for finger pain. • Paying £150 compensation for the distress and inconvenience to Mr B by having his policy unfairly cancelled. As the policy will be reinstated there will be additional premiums due with respect to the period from when the policy was voided up until it is reinstated. So Holloway Friendly should allow Mr B to set up a flexible repayment option for these charges if needed. My final decision I uphold this complaint against The Original Holloway Friendly Society Limited and direct them to put things right in the way I’ve outlined above. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr B to accept or reject my decision before 16 January 2026. Georgina Gill Ombudsman

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