Not upheld: Motor insurance, claim handling complaint against Aioi Nissay Dowa Insurance UK Limited

Decision detail

Summary

Mr L complained about Aioi's handling of a motor insurance claim following a collision abroad in July 2023, where he disputed liability. Mr L alleged that Aioi had not kept him regularly updated and had not pursued sufficient enquiries to establish the facts. Aioi accepted it could have communicated better and paid £75 compensation, but maintained it had acted fairly in its liability investigations. The ombudsman found that Aioi acted reasonably given the available evidence did not clearly establish liability, the third-party's account had not been received, and the international nature of the claim created additional complexities. The ombudsman upheld the £75 compensation as fair but did not uphold the broader complaint about claims handling.

The Ombudsman's reasoning

The ombudsman found that Aioi acted fairly and reasonably in managing the claim. While the third-party's version of events had not been obtained at the time of complaint, the available evidence did not clearly establish who was responsible for the incident. Therefore, it was not unreasonable for Aioi to manage Mr L's expectations by explaining the claim might be settled on a split liability basis. The ombudsman noted that the collision occurring abroad created additional complexities involving multiple parties, which could impact the speed of progress. The £75 compensation for poor communication was found to be fair and proportionate. The ombudsman clarified that determining liability is a matter for the courts, not the ombudsman, and that Aioi has the contractual right to defend or settle claims as it sees fit, provided it acts fairly and reasonably.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website