Not upheld: unfair claim decline complaint against INTACT INSURANCE UK LIMITED trading as RSA

Decision detail

Summary

Mr S complained that RSA unfairly declined his legal expenses insurance claim for employment tribunal proceedings following his redundancy. RSA had obtained assessments from a legal firm and a barrister, both concluding the claim lacked the required 'reasonable prospects of success' (defined as at least 51% likelihood). Mr S argued the assessments were inadequate and failed to properly consider material evidence. The ombudsman found RSA reasonably relied on both assessments, which were sufficiently detailed and reasoned, contained no obvious material factual errors, and were completed by appropriately qualified professionals. The ombudsman declined to assess the quality of the legal advice itself, as this falls outside FOS jurisdiction, and upheld RSA's decision to decline cover.

The Ombudsman's reasoning

The ombudsman applied the established FOS approach that it is fair for an insurer to rely on assessments completed by suitably qualified legal professionals, provided the assessment contains no obvious material factual errors and is suitably reasoned. The ombudsman found both the paralegal's assessment (adequately supervised by a senior solicitor) and the barrister's assessment were sufficiently detailed and reasoned to permit RSA to rely on them. The ombudsman noted that assessing the quality of legal advice and whether it properly considered evidence falls outside FOS jurisdiction. The ombudsman found no obvious material factual errors in either assessment and concluded RSA reasonably relied on them to decline cover.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website