Not upheld: Home insurance claim disputes complaint against Aviva Insurance Limited

Decision detail

Summary

Mrs H complained that Aviva Insurance Limited required her to pay a £250 excess twice for the same claim—once for the 2024-25 policy year and again for the 2025-26 policy year—when her major surgery and subsequent ongoing treatment spanned both policy years. She argued that the excess should only apply once to a single surgical episode and associated recovery. The ombudsman reviewed the policy terms, which explicitly state that the excess applies per policy year and provides an example of treatment continuing across policy years. The ombudsman found that Aviva applied the excess consistently to all policyholders in similar circumstances and therefore did not act unfairly, despite acknowledging Mrs H's reasonable expectation and sympathising with her situation. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy terms explicitly state the excess applies to each member every policy year, and that if treatment continues from one policy year to the next, the excess applies again. The policy wording provided a clear example of this scenario. While the ombudsman acknowledged Mrs H's reasonable expectation and sympathised with her situation, the key test was whether Aviva applied the excess consistently to all policyholders in similar circumstances. The ombudsman was satisfied that Aviva treats all policyholders the same way and therefore did not single out Mrs H unfairly. The ombudsman concluded that Aviva acted reasonably in applying the excess at the start of the 2025-26 policy year in accordance with the contractual terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website