Not upheld: Travel / life insurance claim disputes complaint against Avon Insurance Plc

Decision detail

Summary

Ms A held an accident protection policy with Avon Insurance Plc and claimed benefits following a nervous breakdown and subsequent mental health difficulties. She alleged an accident occurred during a phone conversation with an ex-colleague post-resignation, where she believed her private medical information was disclosed. Avon declined the claim on the basis that no accident had occurred. The ombudsman upheld Avon's decision, finding that the phone conversation did not constitute an accident or result in bodily injury as defined by the policy terms, and that the available medical evidence did not establish permanent total disability.

The Ombudsman's reasoning

The ombudsman found that the policy clearly defined 'accident' as 'a sudden and unforeseen event which happens by chance after the start date and results in bodily injury' and 'bodily injury' as 'injury to your body (excluding sickness, disease or any naturally occurring condition or degenerative process) resulting from external violent and visible means'. The phone conversation, while unpleasant, did not constitute an accident or bodily injury under these terms. Additionally, the psychiatrist's report did not explicitly state permanent total disability but rather indicated Ms A's temporary inability to work at that time based on her beliefs and obstacles to returning to work, not permanent disablement.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website