Not upheld: Home insurance claim disputes complaint against Avon Insurance Plc

Decision detail

Summary

Mrs B complained that Avon Insurance Limited unfairly declined a claim on an accidental death policy following her husband Mr B's death in April 2020. Avon declined the claim on the basis that Mr B did not die solely and directly from bodily injury caused by an external violent and visible cause, as required by the policy terms. The death certificate listed pneumonia, Covid-19, pulmonary fibrosis, COPD, myocardial infarction and hypertension as causes of death. Mrs B's son provided articles suggesting Covid-19 transmission could constitute assault and referenced USA accidental death insurance law. The ombudsman upheld Avon's decision, finding that death from Covid-19 results from viral infection rather than external violence, and that the policy terms were fairly applied.

The Ombudsman's reasoning

The ombudsman concluded that all four policy conditions must be satisfied for payment. The death certificate showed Mr B died from pneumonia, Covid-19, and underlying conditions, not from an external violent and visible cause. Covid-19 causes illness through viral infection rather than external violence. The articles provided about deliberate infection and USA insurance law were given limited weight as there was no evidence of deliberate infection and USA law differs from UK law. The policy terms were fairly applied to decline the claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website