Not upheld: underwriting decision and premium rating fairness complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mr and Mrs W complained that Aviva unfairly declined critical illness cover and applied a 150% rating to life insurance for Mr W due to his muscular dystrophy. Aviva maintained their decision was fair and reflected their underwriting guidance, and offered a policy outside their usual terms. The ombudsman found Aviva acted fairly in making this commercial underwriting decision and in offering cover outside their normal process, rejecting Mr W's arguments that his individual circumstances were not properly considered or that the premium should be broken down to show how it was calculated.

The Ombudsman's reasoning

The ombudsman found that Aviva is entitled to make commercial decisions about what cover to offer and at what price. Although Mr W felt his individual circumstances were not adequately considered, the ombudsman was satisfied that Aviva acted fairly by referring the complaint to an underwriter for review and agreeing to offer life cover outside their usual underwriting terms, which would normally decline cover entirely for his condition. The ombudsman rejected the argument that the premium should be broken down to reflect personal circumstances, finding that Aviva is entitled to set premiums for manual underwriting decisions made in consultation with reinsurers.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website