Not upheld: mis-selling / incomplete disclosure of policy terms complaint against Atlanta Insurance Intermediaries Limited trading as Safeguard

Decision detail

Summary

Ms M purchased legal expenses insurance as an add-on to home insurance through Safeguard and subsequently made a claim for medical negligence costs, which was declined. She complained that the IPID provided at purchase suggested her claim would be covered and that full policy terms were not made available. The ombudsman found that the IPID reasonably directed her to full terms and conditions, and that even if she had reviewed those terms and determined the policy unsuitable, she would not have been able to secure alternative suitable cover for a medical negligence matter that had already occurred before the policy was purchased. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that while the IPID was a summary document, it reasonably directed Ms M to the full terms and conditions. Legal expenses insurance is typically sold on a 'before the event' basis covering future events, not 'after the event' cover for pre-existing claims. Even if Ms M had reviewed the full terms and found the policy unsuitable, she would not have been able to secure alternative suitable cover for a medical negligence claim that had already occurred and was known to be the subject of a likely claim. The ombudsman also noted that Ms M retained the benefit of the broader cover provided by the policy for other potential legal actions.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website