Not upheld: Fraud reimbursement (APP scams) complaint against Aioi Nissay Dowa Insurance UK Limited
Financial Ombudsman decision DRN-5724096 of 2025-09-19T00:00:00+00:00. Fraud reimbursement (APP scams) complaint against Aioi Nissay Dowa Insurance UK Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-5724096 |
|---|---|
| Decision date | 2025-09-19T00:00:00+00:00 |
| Firm | Aioi Nissay Dowa Insurance UK Limited |
| Product | Motor insurance |
| Claim type | Fraud reimbursement (APP scams) |
| Outcome | Not upheld |
| Remedy | None. The complaint was not upheld. ANDI is entitled to recover the claim settlement amount from Miss A under the fraud term of the policy. |
Summary
Miss A purchased a car in February 2025 and made an insurance claim with ANDI, which settled by paying £8,003 based on a market value of £8,153. Miss A disputed this, claiming she had paid £8,995 for the car. When ANDI investigated, it found the handwritten invoice receipt appeared tampered with and discovered through the garage that Miss A had only paid £7,650 (£200 deposit and £7,440 bank transfer), with an additional £1,345 claimed as cash payment that could not be evidenced. ANDI applied its fraud term and sought to recover the settlement amount. The ombudsman upheld ANDI's decision, finding it had reasonably applied the fraud term based on the discrepancies between the claimed purchase price and the evidence available.
The Ombudsman's reasoning
The ombudsman found that ANDI reasonably applied its fraud term based on the evidence available. The handwritten invoice appeared tampered with, Miss A could only evidence £7,640 of the claimed £8,995 purchase price through bank statements and garage confirmation, and the car was advertised for less than the amount Miss A claimed to have paid. The ombudsman noted that the unevidenced cash payment and discrepancies between the claimed price and advertised price supported ANDI's conclusion that Miss A had breached the fraud term.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Aioi Nissay Dowa Insurance UK Limited, all decisions | 55 | 38% |
| Fraud reimbursement (APP scams), all decisions | 19,453 | 22% |
| Motor insurance, all decisions | 24,036 | 35% |
Source
Read the original decision on the Financial Ombudsman Service website