No scope for judicial review of FOS (Financial Ombudsman Service) decision

Mickovski v Financial Ombudsman Service Limited & Anor [2012] VSCA 185

The proceeding concerned a challenge by Mickovski to a decision of the Financial Ombudsman Service Limited (FOS) that it lacked jurisdiction to deal with a complaint made by him in relation to entitlements allegedly payable by MetLife Insurance Ltd (MetLife).

Background Facts

Mickovski was injured in a workplace accident in February 1995. He claimed and was paid salary continuation benefits under an insurance policy issued by MetLife (SCI Policy). Mickovski subsequently claimed a TPD benefit under a second MetLife insurance policy. MetLife ceased SCI payments in July 1999 and paid Mickovski a TPD benefit in August 1999. At that time, both Mickovksi and MetLife were acting under a misconception that the SCI Policy provided for the cessation of SCI benefits upon Mickovski becoming totally and permanently disabled.

In 2006 Metlife applied to the Court to rectify the SCI policy so that the benefit period ceased upon the insured member becoming totally and permanently disabled. Rectification was granted on 13 November 2007. Thereafter, Mickovski sought to reinstate and backdate SCI benefits from July 1999 on the basis he was not totally and permanently disabled as defined under the rectified SCI Policy. MetLife rejected Mickovski's SCI reinstatement claim on 7 October 2008. Mickovski lodged the FOS complaint in December 2008.

FOS Decision

The FOS Terms of Reference prevented FOS from dealing with complaints where the complainant knew or should reasonably have known of all the relevant facts more than six years before first...