Not upheld: claims handling - unreasonable delay and customer service failures in claim assessment complaint against AXA Insurance UK Plc

Decision detail

Summary

Mr G, a landlord, claimed on his Commercial and Residential Landlords' insurance policy following a claim by tenants alleging disrepair caused personal injury. Medical reports identified psychological injury (anxiety and low mood) rather than physical bodily injury. AXA rejected the claim, concluding it was not covered under the policy's Property Owner's Liability section as it did not involve bodily injury and disrepair claims were excluded. Although AXA's claim decision was reasonable and supported by legal advice, it failed to promptly review the medical reports after receiving them in November 2023 and should have advised Mr G sooner. The ombudsman upheld AXA's £600 offer for distress and inconvenience caused by these delays but rejected Mr G's request for contribution to the £11,000 settlement, as the claim was not covered by the policy.

The Ombudsman's reasoning

The ombudsman found that AXA correctly applied the policy terms in rejecting the claim. The policy's 'Property Owner's Liability' section could only cover accidental bodily injury, and the medical reports identified only psychological injury (anxiety and low mood) without a recognised psychological diagnosis. The legal advice AXA obtained reasonably supported the conclusion that this did not meet the policy definition of bodily injury. However, AXA failed to promptly review the medical reports after receiving them in November 2023 and should have advised Mr G sooner that the claim was not covered. While this caused Mr G stress in having to appoint solicitors at short notice, there was no clear financial loss as the claim settled for less than the original offer. The £600 already offered by AXA was reasonable compensation for the distress and inconvenience caused by these delays.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website