Not upheld: unfair claim decline and alleged service delays complaint against Liverpool Victoria Insurance Company Limited

Decision detail

Summary

Mr and Mrs K complained that LV unfairly declined their legal expenses insurance claim for an employment dispute and caused delays in assessing it. LV's panel solicitors assessed the claim as having only 20-30% prospects of success, below the policy requirement of more than 50% reasonable chance of success, leading to the decline. Mr K later obtained a barrister's assessment suggesting 55% prospects, but the ombudsman found this did not demonstrate LV's solicitor was wrong or lacked access to documents. The ombudsman also found LV did not cause unreasonable delays, as it regularly pursued updates and referred the claim promptly after receiving the ACAS certificate. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that LV acted fairly in relying on its authorised solicitor's professional assessment that the claim had only 20-30% prospects of success, which fell below the policy's requirement of more than 50% reasonable chance of success. The ombudsman was satisfied the solicitor was suitably qualified and experienced, and there was no evidence the assessment was based on factual mistakes or that documents were not passed to the solicitor. Regarding delays, LV was regularly chasing for updates and referred the claim promptly after receiving the ACAS certificate. The fact that a barrister later reached a different conclusion (55%) does not mean LV's solicitor was wrong or lacked access to documents.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website