Not upheld: unfair claim decline complaint against Amtrust Specialty Limited

Decision detail

Summary

Mr W complained that Amtrust Specialty Limited unfairly declined his legal expenses insurance claim following an employment dispute. Amtrust's lawyer assessed the claim lacked reasonable prospects of success (below the 51% policy threshold), and maintained this view after Mr W provided additional evidence. Mr W argued his own solicitor had assessed a 70% chance of success. The ombudsman found Amtrust acted fairly by relying on its qualified lawyer's well-reasoned assessments, as Mr W's legal advice was insufficiently detailed and reasoned to contradict them. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman determined that Amtrust was entitled to rely on its lawyer's assessments because they were properly written, well-reasoned, and from a suitably qualified employment lawyer. The ombudsman found that Mr W's own legal advice was insufficiently detailed and reasoned, as it did not explain how the 70% figure was calculated or how the facts were weighed. The ombudsman was not required to determine the actual merits of the prospects of success, only whether it was fair for Amtrust to rely on its lawyer's assessments given the evidence available.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website