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

Decision detail

Summary

Mrs W complained that SCOR unfairly declined her legal expenses insurance claim for an equal pay dispute with her employer. SCOR relied on a policy exclusion covering disputes existing at the policy start date that the insured believed or ought reasonably to have believed could lead to a claim. The ombudsman found the dispute clearly predated the policy (originating in July 2022) and that Mrs W, being in active dispute with her employer, ought reasonably to have foreseen it could lead to a legal claim. The ombudsman upheld SCOR's decision as a fair application of the policy terms designed to prevent cover for known problems.

The Ombudsman's reasoning

The ombudsman found that the dispute clearly existed before the policy start date, as evidenced by Mrs W's own statements that the matter had been ongoing since July 2022. Although Mrs W argued she did not believe the dispute could lead to a claim because she was attempting informal resolution, the ombudsman rejected this interpretation. The policy exclusion is designed to prevent policyholders from obtaining cover for known problems, and Mrs W was already in an active dispute with her employer when she took out the policy. Therefore, she ought reasonably to have believed the dispute could lead to a claim, bringing it within the exclusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website