Not upheld: mis-selling and policy clarity complaint against Hiscox Insurance Company Limited

Decision detail

Summary

Mr W, a pilot, purchased a loss of licence top-up insurance policy in 2020 and renewed it annually. When he made a claim in 2024 after becoming unfit for work in December 2023, Hiscox stated that long-term sickness required 36 months or more without prospect of licence restoration. Mr W complained that the definition was unclear and that he would have chosen a different policy had this been made clear. The ombudsman found the 36-month definition was clearly stated in the policy document Mr W read and confirmed he accessed annually. Although the policy referred to a long-term unfitness assessment no longer issued by the Licence Issuing Authority, the policy included a fallback provision for medical review, so Mr W was not precluded from claiming. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy definition of long-term unfitness (36 months or more without reasonable prospect of licence restoration) was clearly set out in the policy document that Mr W had access to and confirmed he read. Although the policy referred to a document no longer produced by the Licence Issuing Authority, the policy terms included a fallback provision allowing Hiscox to review medical evidence and consider payment based on medical adviser opinion. The ombudsman acknowledged this was unfortunate but did not find Mr W was prejudiced or precluded from making a claim. Hiscox did not decline the claim and offered review by an aviation medical expert.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website