Not upheld: Home insurance claim disputes complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mrs S claimed on her income protection insurance policy after becoming unable to work due to fibromyalgia, chronic pain and chronic fatigue. Aviva declined the claim based on a chronic pain condition exclusion in the policy terms. Mrs S complained that fibromyalgia was not specifically named in the exclusions and that her reasons for absence were more complex. The ombudsman found that Aviva reasonably applied the exclusion since Mrs S identified chronic pain and chronic fatigue as the specific symptoms preventing her from working, and the policy exclusion covers claims caused by or resulting from these conditions regardless of whether the underlying condition is specifically named.

The Ombudsman's reasoning

The ombudsman found that the policy exclusion clearly states any claim caused by or resulting from chronic fatigue or chronic pain is excluded, regardless of whether the specific condition is named. Since Mrs S identified chronic pain and chronic fatigue as the specific symptoms preventing her from working, it was reasonable for Aviva to apply the exclusion. The exclusion does not require the condition to be specifically named for it to apply.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website