Not upheld: claim denial — income protection complaint against Liverpool Victoria Financial Services Limited

Decision detail

Summary

Miss K claimed on an income protection policy with own occupation cover, but LV declined the claim on the basis that her absence from work was due to workplace stress rather than illness. Miss K appealed and subsequently complained to the FOS, arguing that medical evidence supported a valid claim. The ombudsman reviewed the case and found that contemporary medical evidence consistently attributed Miss K's absence to workplace issues, not illness. The ombudsman concluded that stress is not generally considered an illness and that Miss K failed to demonstrate she met the policy definition of incapacity. The complaint was not upheld and no remedy was ordered.

The Ombudsman's reasoning

The ombudsman concluded that Miss K failed to demonstrate she had a valid claim under the policy definition. The contemporary medical evidence consistently attributed her absence to workplace issues rather than illness. Stress is not generally considered an illness and is not typically covered by income protection policies. While anxiety was considered, the primary barrier to Miss K's return to work was identified as workplace issues, not medical incapacity.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website