Arch Insurance (UK) Limited · DRN-6124734

The complaint Mr T is unhappy with how Arch Insurance (UK) Limited handled a claim on his income protection policy. What happened Mr T has an income protection policy underwritten by Arch. He submitted a claim for unemployment cover. Arch Insurance declined cover because they concluded Mr T was in temporary work and, therefore, wasn’t eligible to claim under the policy. Arch also cancelled the policy and refunded Mr T the premiums he’d paid. Mr T didn’t agree he was in temporary work. He said Arch had treated him unfairly, so he referred a complaint to this service. Our investigator looked at everything and said Arch had fairly declined the claim. And she thought the refund of premiums was reasonable in the circumstances. Mr T disagreed. In summary he said Arch should’ve known his work status based on the name of the employer paying his income. And he provided evidence to show he was still employed by the same company. The case has been passed to me to decide. 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. I may not respond to every point that has been raised, but I want to reassure both parties that I’ve considered everything that’s been submitted. The informal nature of this service enables me to do that so I can resolve complaints with minimal formality. The relevant rules and industry guidelines say an insurer has a responsibility to handle claims promptly and fairly and shouldn’t reject a claim unreasonably. The policy terms state: ‘You can make a claim for Unemployment if all of the following apply. • You become unemployed during the term of this policy and since the last cover increase date. • You have been actively employed in your normal job or occupation for at least 6 consecutive months immediately prior to becoming unemployed. • You are available and actively looking for work. You may be asked to provide evidence of this.’

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The policy also excludes claims: ‘If you are self-employed or in temporary work’ Mr T feels strongly that he shouldn’t be considered a temporary worker. He has explained his length of service with his current company, the hours he works and that he pays national insurance contribution. However, the insurer is entitled to rely on the evidence they received from Mr T’s employer when they asked them about the status of his employment. Mr T’s employer told Arch he was employed as a temporary worker, with temporary assignments. And they confirmed his rate of pay varies depending on the temporary role he’s placed in. I’m satisfied it was reasonable for Arch to rely on the evidence from Mr T’s employer as they are best placed to provide information on his employment status. And I think it was fair for Arch to then decline cover because Mr T’s policy doesn’t cover temporary workers. I appreciate Mr T has provided evidence to show he is still working for the same company. However, I still think it fair for Arch to conclude he was a temporary worker based on what his employer told them. Arch has refunded the premiums Mr T paid because they said the policy should never have been taken out in the first place. I’ve considered the questions Mr T was asked about his employment at the point of sale, but he wasn’t specifically asked about whether he was in temporary work or not. So I don’t think there’s any misrepresentation involved here. As Arch confirmed Mr T would never have been able to benefit from this policy, I think it was fair for them to refund the premiums in the way that they have. Mr T said Arch should’ve known his work status based on the name of the employer paying his income. But I don’t think this is reasonable. I’m satisfied Arch fairly collected premiums for this policy based on the information provided to them at the sale, and it was fair for them not to review Mr T’s circumstances in more detail until he’d submitted a claim. And for the reasons already explained above, I’m satisfied Arch then went on to assess his claim fairly. I know this will be disappointing to Mr T, but there isn’t anything further I could reasonably ask Arch to do here. My final decision I don’t uphold this complaint for the reasons I’ve explained. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr T to accept or reject my decision before 28 April 2026. Georgina Gill Ombudsman

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