Not upheld: Home insurance claim disputes complaint against AmTrust Specialty Limited

Decision detail

Summary

Ms S complained that AmTrust unfairly declined her legal expenses insurance claim relating to a potential home purchase based on an assessment from panel solicitor L concluding the claim was unlikely to succeed. Ms S objected that L's initial assessment was incomplete and that she had not been properly consulted, leading to a second assessment which also concluded the claim was unlikely to succeed. Ms S argued AmTrust should fund an assessment from a different solicitor of her choice. The ombudsman found that AmTrust reasonably relied on the second assessment, which was properly reasoned, supervised by a qualified solicitor, and free of obvious factual errors, and that the policy's requirement of 51% or greater prospects of success is a standard and fair term. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the standard approach to legal expenses insurance claims: insurers can reasonably rely on properly reasoned opinions from suitably qualified legal professionals provided there are no obvious material factual errors apparent to a layperson. The second assessment was properly reasoned, supervised by a qualified solicitor, and contained no obvious factual errors. While Ms S received poor service from L, this did not invalidate the assessment itself. The policy terms requiring reasonable prospects of success and use of panel solicitors are common, fair, and reasonable. Ms S must obtain and fund her own assessment if she wishes AmTrust to reconsider.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website