The man made a complaint to the Insurance and Financial Services Ombudsman about a claim filed in December 2017.

He suffered a significant injury in October that year that left him confined to bed, then in a wheelchair until January.

He made a claim for total temporary disability (TTD), which was accepted.

But the insurer advised it would cease to pay the claim from January 2018 when medical evidence stated he was no longer confined to a wheelchair.

The insurer stated the benefit was only payable while he was confined to bed or a wheelchair as, at the time of the injury, he was not working in his seasonal job and so did not count as an "earner" under the policy.

The insured argued the definition was too narrow. 

He said he had always been the "breadwinner" and was an "earner" and as such should have his benefit paid until he could return to work.

An IFSO case manager explained that the insurer was only legally required to pay if he met the definition of TTD under the policy, and in turn, the definition of “earner”.

The insured requested the insurer refund his premiums from the date it ceased to pay the TTD claim as the policy would be unlikely to offer him comprehensive cover in the future.

The insurer agreed to offer an ex-gratia payment of the amount of his premiums he had paid from January 2018 if he agreed to retrospectively cancel the policy from that date, which the insured accepted.