Not upheld: claim declined / policy coverage exclusion complaint against ARAG Legal Expenses Insurance Company Limited

Decision detail

Summary

Ms W claimed on her ARAG legal expenses insurance policy for cover to bring judicial review challenges against police constabularies regarding their investigation decisions. ARAG declined the claim, stating it was not covered under the policy. Ms W argued the claim should be covered under the personal injury section. The ombudsman examined the policy terms and found that judicial review claims against police did not fall within any section of cover, and the personal injury section only covered claims arising from sudden accidents causing bodily injury. The complaint was not upheld as ARAG correctly declined cover for a claim type not provided for in the policy.

The Ombudsman's reasoning

The ombudsman examined the policy terms carefully and determined that Ms W's claim for judicial review of police decisions did not fall within any of the defined sections of cover. The personal injury section only covers claims arising from a specific or sudden accident causing bodily injury, and excludes psychological injury unless following physical bodily injury from a sudden accident. Ms W's claim related to challenging police decisions about alleged offenses, not a sudden accident causing bodily injury. Therefore, ARAG was entitled to decline the claim as the policy simply did not provide cover for this type of legal action.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website