Not upheld: claim decision - fault determination complaint against Haven Insurance Company Limited

Decision detail

Summary

Mr H complained that Haven Insurance wrongly determined he was wholly at fault for a motor accident in September 2024 and sought the incident be recorded as non-fault with restoration of his no-claims bonus and payment of associated costs. Haven maintained their fault determination. The ombudsman found that while the FOS cannot act as an appeal mechanism for claim decisions, it must ensure insurers act reasonably and fairly. The ombudsman was satisfied Haven properly considered all evidence, gave Mr H full opportunity to present his position, and reasonably explained their decision based on applicable law and road rules. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman confirmed that while it is not the FOS's role to independently determine fault or act as an appeal mechanism against claim decisions, it is appropriate to expect the insurer to make a reasonable decision based on available information and explain it. The ombudsman was satisfied that Haven properly considered all evidence, gave Mr H full opportunity to present his case, and reasonably explained why they believed they would lose if the case went to court. Therefore, Haven did not act unfairly or unreasonably.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website