Not upheld: Motor insurance, claim handling complaint against Society of Lloyd's

Decision detail

Summary

Mr C claimed a fixed daily benefit under his personal accident insurance policy following a car accident injury in August 2024. Society of Lloyd's paid the claim in November 2024, approximately three months later, after requesting additional medical evidence beyond the initial GP statement. Mr C complained about the delays and their alleged impact on his credit score and financial situation. Society of Lloyd's offered £150 compensation, which Mr C rejected and escalated to the FOS. The ombudsman found the delays partially justified by reasonable claims investigation requirements and determined that the £150 compensation was fair, declining to uphold the complaint or award additional compensation.

The Ombudsman's reasoning

The ombudsman accepted that delays occurred but found them partially justified by the need for reasonable investigation and evidence. The term 'immediate benefit' does not mean instant payment without evidence. Society of Lloyd's was entitled to obtain further medical information to verify the claim. While delays from 13-28 August and 18 October-22 November were acknowledged, delays caused by the GP were not Society of Lloyd's' responsibility. The ombudsman found no evidence that Society of Lloyd's delays were the sole cause of credit score damage and determined that consequential financial losses were not reasonably foreseeable. The £150 compensation offer was proportionate and fair under FOS guidance.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website