Not upheld: claims handling and cover withdrawal complaint against Aviva Insurance Limited

Decision detail

Summary

Mr B and Ms V complained about how Aviva Insurance Limited handled a travel insurance claim after Mr B was hospitalized abroad with suspected angina in July 2025. Aviva requested Mr B attend a cardiology appointment to confirm fitness to fly before continuing coverage, but Mr B refused to attend unless the cardiologist had access to comprehensive medical records from the hospitals and his UK medical history. Aviva maintained that the discharge report and cardiologist consultation would be sufficient and warned that cover would be withdrawn if Mr B did not attend the appointment on 18 August 2025. When Mr B failed to attend, Aviva withdrew cover but agreed to cover repatriation once he was deemed fit to fly. The ombudsman found Aviva acted fairly and reasonably in its approach and accepted the £400 compensation offered for procedural errors as appropriate.

The Ombudsman's reasoning

The ombudsman found that Aviva reasonably requested a cardiology appointment to assess fitness to fly, as neither hospital had provided this assessment. The ombudsman accepted Aviva's medical team's advice that a cardiologist could make this assessment based on consultation, discussion of history, and the discharge report without requiring full historical records. The ombudsman noted that waiting for Mr B's medical records could take many weeks and it would be unreasonable to expect Aviva to do so. The ombudsman found Aviva gave reasonable notice of the cover withdrawal deadline and acted fairly in withdrawing cover when Mr B failed to attend. The ombudsman accepted that the £400 compensation fairly reflected the distress caused by Aviva's procedural errors (failing to inform Mr B earlier about the fitness to fly requirement and the confusion caused by the initial misunderstanding about appointment dates).

How this compares

Source

Read the original decision on the Financial Ombudsman Service website