Upheld: claim handling failures, failure to provide entitled benefit (physiotherapy referral), service delays complaint against Aviva Insurance Limited
Financial Ombudsman decision DRN-6256103 of 2026-05-18T00:00:00+00:00. claim handling failures, failure to provide entitled benefit (physiotherapy referral), service delays complaint against Aviva Insurance Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6256103 |
|---|---|
| Decision date | 2026-05-18T00:00:00+00:00 |
| Firm | Aviva Insurance Limited |
| Product | car insurance |
| Claim type | claim handling failures, failure to provide entitled benefit (physiotherapy referral), service delays |
| Outcome | Upheld |
| Remedy | No further action required. Aviva has already provided £1,000 compensation and has referred Mr S for physiotherapy following FOS involvement. |
Summary
Mr S claimed on his car insurance policy following an accident in August 2025. Aviva accepted the claim but refused to repair gearbox, clutch and airbag faults, concluding they were caused by wear and tear rather than the accident. Mr S also complained about delays in claim handling, poor communication, an unsuitable courtesy car, and failure to refer him for physiotherapy despite having purchased Increased Personal Accident cover. The ombudsman upheld the complaint only regarding the physiotherapy referral failure, finding Aviva's refusal to repair the other faults was fair based on three expert assessments. The ombudsman found the £1,000 compensation already offered by Aviva to be fair and reasonable, and required no further action as the physiotherapy referral has since been made.
The Ombudsman's reasoning
The ombudsman found that Aviva acted fairly in refusing to repair the gearbox, clutch and airbag faults because three experts (including an independent engineer) all concluded these were caused by wear and tear rather than the accident. The ombudsman gave greatest weight to the independent expert reports over Mr S's evidence (MOT pass and dashcam footage), as these do not definitively prove the faults were accident-related. However, the ombudsman upheld the complaint regarding the failure to refer Mr S for physiotherapy when he had purchased Increased Personal Accident cover and reported back pain. The ombudsman found the £1,000 compensation already offered by Aviva to be fair and reasonable for the claim handling delays, complaint logging delay, lack of proactive updates, and late physiotherapy referral. The ombudsman rejected Mr S's complaint about the courtesy car as Aviva was contractually entitled to provide only a small hatchback, and even went beyond its obligations by upgrading it.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Aviva Insurance Limited, all decisions | 5,078 | 27% |
Source
Read the original decision on the Financial Ombudsman Service website