Not upheld: claim decision reasonableness, claim handling delays, communication failures complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mr W complained about Legal and General's handling of his income protection insurance claim following absence from work due to fibromyalgia and back pain. Legal and General accepted the claim but initially agreed to pay full benefit for only three months before reducing to 50%, which Mr W disputed as not reflecting the medical evidence. Mr W also complained about claim handling delays and communication failures, including a point of contact who was unavailable by phone. The ombudsman found the original claim decision was reasonable based on the medical officer's assessment that Mr W had capacity for partial work, the claim was handled promptly, and communication, while imperfect, was adequate. The complaint was not upheld and no remedy was ordered.

The Ombudsman's reasoning

The ombudsman found that Legal and General's original claim decision to pay full benefit for three months then reduce to 50% was reasonable based on the available medical evidence and the medical officer's opinion that Mr W had capacity for sustained partial work. The medical officer's assessment was not inconsistent with available evidence and it was reasonable to rely upon it. The claim was handled promptly, taking less than two months from evidence gathering to decision communication. While communication could have been better in some respects (follow-up letters not always provided, one missed callback), Mr W was kept regularly updated and the single point of contact arrangement was reasonable given the volume of his contact. The later decision to continue full benefit was explained by new information from the clinical psychologist.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website