Not upheld: claim decline - insufficient evidence of incapacity complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mr P, a beneficiary of an income protection insurance policy with Aviva, claimed on the policy but the claim was declined due to insufficient evidence of incapacity. Mr P complained that Aviva should have explained what evidence was needed and that their request for information about a court order was unreasonable. The ombudsman found the claim was fairly declined because the medical evidence was limited and did not demonstrate inability to perform job duties as required by the policy definition. The ombudsman also found that Aviva reasonably sought information about the court order given its potential legal implications and links to the claim circumstances.

The Ombudsman's reasoning

The ombudsman concluded that the medical evidence was limited and did not demonstrate that Mr P was unable to perform his job duties due to illness or injury as required by the policy definition. The ombudsman found it was reasonable for Aviva not to specify what evidence was needed, as it is the claimant's responsibility to demonstrate a valid claim. The ombudsman also found that workplace issues linked to the court order provided an additional fair basis for declining the claim, and that Aviva reasonably sought to understand the court order given its potential legal implications for settlement.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website