Not upheld: Travel / life insurance claim disputes complaint against SCOR UK Company Ltd

Decision detail

Summary

Ms D complained that SCOR UK Company Ltd wrongfully refused her legal expenses insurance claim relating to a property boundary dispute with her neighbour. Ms D claimed she had notified SCOR of the incident in 2015/16 and was told the claim was not covered, but when she resubmitted the claim in 2023, SCOR again refused it. SCOR had no records of any prior contact or claim from Ms D. Although Ms D provided a broker's email from March 2016 and a solicitor's letter from the same period, the ombudsman found these did not constitute convincing independent evidence that she had notified SCOR of the claim. The ombudsman upheld SCOR's refusal, finding the policy's requirement to report claims during the period of insurance was standard and fair, and that Ms D had failed to provide sufficient evidence of notification.

The Ombudsman's reasoning

While the ombudsman acknowledged Ms D's recollection and noted some force to her argument that she would not have instructed a solicitor without checking insurance, there was no convincing independent evidence that she made a claim to SCOR in 2015/16. The email from the broker and solicitor's letter, while showing timing consistency, do not prove that Ms D notified SCOR of the claim or that SCOR assessed and refused it. The policy terms requiring claims to be reported during the period of insurance and as soon as the insured became aware are standard and not unfair. Without evidence of notification, SCOR cannot reasonably be required to meet the claim eight years later.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website