Covea Insurance plc · DRN-6120706

The complaint Mr K has complained that Covea Insurance plc declined a claim he made on a credit card payment protection insurance policy. What happened Mr K lost his job in March 2023 and so made a claim on the policy. However, it was declined by Covea on the basis that his unemployment was the result of his own misconduct, which is not covered under the policy terms. I wrote a decision in May 2024 in which I explained why I thought Covea had acted reasonably in declining the claim. At that time, Mr K was taking his former employer to an employment tribunal. Covea had said that it would look at the claim again if the outcome of the tribunal was in Mr K’s favour, which I also thought was reasonable. Following the tribunal, which Mr K didn’t win, he resubmitted the claim. Covea declined it again, on the same basis as previously. Our investigator thought that Covea had acted reasonably in declining the claim. Mr K disagrees and so the complaint has been passed to me for 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. I’ve carefully considered the obligations placed on Covea by the Financial Conduct Authority (FCA). Its ‘Insurance: Conduct of Business Sourcebook’ (ICOBS) includes the requirement for Covea to handle claims promptly and fairly, and to not unreasonably decline a claim. The policy terms state: ‘What is not covered by Unemployment Insurance? We will not pay Unemployment benefit if: ii) You ceased to be Employed as a result of Your misconduct’ The basis of Mr K’s original complaint was that his employment had been terminated due to ‘Some other Substantial Reason’ (SOSR), which was distinct from the disciplinary process of a misconduct hearing. Whilst the SOSR panel had concluded that there had been an irretrievable breakdown of trust and confidence between Mr K and his employer, that breakdown was noted as being due to the language and behaviours that Mr K had demonstrated, which had been deemed to be highly inappropriate.

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I’d concluded in my previous decision that, although his employer had used the mechanism of a SOSR hearing to remove his from post, it was fair for Covea to characterise his behaviour leading up to that as misconduct. Therefore, I concluded that it was fair for Covea to conclude that his unemployment was the result of his own misconduct. I’m not persuaded that much has substantively changed since then. Mr K has now been through the employment tribunal process and, as already mentioned, the tribunal did not find in his favour. Nevertheless, he feels that the judgement supports his position that misconduct was not the reason for his job loss. In particular, he has highlighted that the judgement states: ‘We concluded that the claimant’s conduct was not why he was dismissed. As already stated, the respondent dismissed the claimant because there had been an irretrievably breakdown in the working relationship.’ Covea had understood that SOSR was the substantive reason for his dismissal. However, it had looked behind that reason to conclude that misconduct was a significant contributing factor to that outcome. I consider it reasonable that Covea took that approach. So, the question now is, does the evidence from the employment tribunal mean that Covea should think again. Mr K’s employer had concerns about his language and behaviour. As conduct relates to the manner in which someone behaves, I’m satisfied that their concerns related to his conduct (or misconduct). They said they viewed the matter as wider than a conduct issue – but that’s not to say that there was no issue of misconduct, rather, it had wider ramifications. They said that his actions had negatively impacted its reputation with a third party and that it was potentially a reputational risk for the organisation. His language and behaviour was described as extreme, highly inappropriate and distressing to others. It was also noted that it extended over a significant period of time. The tribunal thought it was reasonable for his employer to conclude that he was likely to continue with these behaviours and language. Mr K’s representative at the tribunal sought to argue that his language and behaviours ought to have been treated as a conduct matter and that the potentially fair reason for dismissal was conduct and not SOSR. I appreciate this argument was being made to draw attention to a possible procedural issue. However, in allowing his lawyers to make that argument, it does highlight that Mr K himself was apparently accepting that his conduct was a factor in the breakdown of the relationship with his employer that led to his dismissal. It’s reasonable that Covea has considered this evidence and weighed it against the other elements of the case. Whilst the tribunal was satisfied that the employer had shown that the reason for dismissal was SOSR due to the relationship of trust and confidence having been irretrievably broken, the reason for that break down was due to his language and behaviours. I’ve thought very carefully about what Mr K has said, including his response to the investigator’s assessment, and appreciate the technical basis of his argument about the reason for his dismissal as set out in the employment tribunal – even though his own representative argued against it. However, in looking at what is fair and reasonable, I’m satisfied that Covea acted reasonably in assessing the available evidence to conclude that his unemployment was the result of his own misconduct. It follows that I do not uphold the complaint. My final decision For the reasons set out above, I do not uphold the complaint.

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Under the rules of the Financial Ombudsman Service, I’m required to ask Mr K to accept or reject my decision before 27 April 2026. Carole Clark Ombudsman

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