A former professional rugby player submitted a claim for permanent total disablement under the Irish Rugby Football Union (IRFU) insurance policy in 2004.

The player had suffered a total dislocation of one knee in August 2000 and had not played professional rugby since. However, his various attempts at rehabilitation had included playing rugby at amateur level. Four years after sustaining his injury, during which time he was under the supervision of the IRFU medical team, it was concluded that he would not be able to return to professional rugby.

But the insurance company rejected the claim, referring to the player's ability to play amateur rugby and the late notification of the claim.

Investigating the player's complaint, the ombudsman found that the policy clearly referred to an inability to play professional rugby as grounds for making a claim. The policy also made no mention of when the claim had to be notified.

Even if the insurer had been able to medically assess the player, it would not have changed the fact that the injury was a career-ending one.

The ombudsman found that the insurer should have compensated the player for his loss of employment and he directed the company to pay him the full benefit of €190,461, plus another €10,000 in compensation for the distress and expense caused.