Not upheld: claims funding decision and legal assessment reliance complaint against Aviva Insurance Limited

Decision detail

Summary

Mr P complained that Aviva treated him unfairly by declining to fund his legal claims based on assessments from their panel firm and refusing to fund his own choice of solicitor. Aviva obtained two legal assessments concluding the claims lacked reasonable prospects of success and proportionality. The panel firm initially failed to consider all of Mr P's claims but acknowledged this error and offered £150 compensation; Aviva funded a second assessment to address this. The ombudsman found Aviva acted fairly in relying on qualified legal advice that was not obviously wrong, proactively ensured comprehensive coverage review, and offered reasonable alternatives for reconsideration. The complaint was not upheld as Mr P had not yet submitted his own legal opinion and alternative dispute resolution outcome back to Aviva for reconsideration.

The Ombudsman's reasoning

The ombudsman applied the standard approach to legal expenses insurance claims: where an insurer obtains advice from suitably qualified lawyers, the ombudsman will not question reliance on that advice unless it was obviously wrong or based on factual mistakes. Aviva obtained two assessments from qualified legal professionals, the assessments were not obviously wrong or based on factual errors, and Aviva proactively ensured all of Mr P's covered claims were considered. The panel firm's initial oversight was acknowledged and compensated. Aviva's offer to reconsider based on new evidence or a supportive legal opinion from Mr P's own solicitor was reasonable and in line with FOS approach. Mr P's complaint was premature as he had not yet submitted the alternative dispute resolution outcome or his own legal opinion back to Aviva for reconsideration.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website