Not upheld: Other regulated complaint complaint against American Internal Group UK Limited

Decision detail

Summary

Mr K claimed permanent disability benefit under his personal accident insurance policy following a car crash caused by a seizure in September 2023. AIG declined the claim relying on a policy exclusion for accidents caused by deliberately putting oneself in danger. Mr K had experienced seizures in 2022 and August 2023, and continued driving after the August seizure without notifying DVLA. The ombudsman upheld AIG's decision, finding Mr K should have known DVLA guidance requiring notification of seizures and cessation of driving, and therefore deliberately put himself in danger by continuing to drive. AIG had paid the fracture benefit and was not required to return it.

The Ombudsman's reasoning

The ombudsman found that Mr K deliberately put himself in danger by continuing to drive after the August 2023 seizure without notifying DVLA, despite knowing (or being reasonably expected to know) DVLA guidance requiring notification of seizures and cessation of driving. The ombudsman concluded that a reasonable person with knowledge of the circumstances would reasonably conclude Mr K was deliberately putting himself in danger. The exclusion was fairly and reasonably applied to decline the permanent disability benefit claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website