Not upheld: Travel / life insurance claim disputes complaint against Financial & Legal Insurance Company Ltd

Decision detail

Summary

Ms N complained that F&L unfairly declined her legal expenses claim for an employment tribunal case alleging race discrimination and victimisation. F&L had obtained a solicitor's opinion concluding the claim had less than a 51% chance of success, falling below the policy's requirement for 'Reasonable Prospects' (more than 50% chance). Ms N objected to reliance on a single opinion, provided over 100 pages of evidence, and later submitted additional tribunal records. When F&L referred the additional evidence to the same solicitor for reconsideration, the solicitor maintained their professional opinion. The ombudsman found F&L acted fairly in relying on the qualified solicitor's detailed reasoning and found no unreasonable delays in claims handling. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied ICOBS 8.1 requirements for fair and prompt claims handling. The policy clearly defined 'Reasonable Prospects' as requiring more than a 50% chance of success. The solicitor's opinion, supported by detailed reasoning, concluded less than 51% chance of success, which fell below the policy threshold. When Ms N provided additional evidence, F&L appropriately referred it to the same solicitor for reconsideration, and the solicitor maintained their professional opinion. The ombudsman found no legitimate concerns about the solicitor's ability to reassess or that the factual landscape had materially changed. The ombudsman also found no unreasonable delays, as the gap in communication was due to Ms N's inability to complete the required claim form, which F&L had repeatedly requested.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website