Not upheld: unfair claim decline complaint against Lloyds Bank General Insurance Limited

Decision detail

Summary

Mr W and Miss E complained that Lloyds unfairly declined a claim for the loss of Mr W's mother's hearing aids within the home. Lloyds declined the claim as loss within the home was not an insured event. Mr W argued the policy did not exclude accidental loss in the home and that the 'accidental damage' section should cover the loss, and he also claimed Lloyds agents had provided misleading information during calls confirming coverage. The ombudsman found the policy terms clearly outlined specific insured events and that loss within the home was not covered, the 'accidental damage' definition required damage not loss, and the agents had provided accurate information. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy clearly outlined cover for specific one-off events such as fire, storm or flood, and loss within the home was not an insured event. The definition of 'accidental damage' in the policy required damage caused by a one-off specific event, but the hearing aids were lost, not damaged. The agents' information during calls was accurate and not misleading, as they correctly explained coverage for accidental damage in the home and loss outside the home. Vulnerability considerations do not override the requirement that claims must be assessed against policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website