Not upheld: unfair claim decline — insufficient medical evidence of permanent total disability complaint against Phoenix Life Limited, trading as Standard Life
Financial Ombudsman decision DRN-6324916 of 2026-05-28T00:00:00+00:00. unfair claim decline — insufficient medical evidence of permanent total disability complaint against Phoenix Life Limited, trading as Standard Life. Outcome: Not upheld.
Decision detail
| Reference | DRN-6324916 |
|---|---|
| Decision date | 2026-05-28T00:00:00+00:00 |
| Firm | Phoenix Life Limited, trading as Standard Life |
| Product | insurance — critical illness cover |
| Claim type | unfair claim decline — insufficient medical evidence of permanent total disability |
| Outcome | Not upheld |
| Remedy | None ordered. The ombudsman stated that if Mr M now consents to his GP sharing the original report, Standard Life should consider its contents and advise whether it satisfies them that the claim should be paid. |
Summary
Mr M and Mrs S complained that Standard Life unfairly declined a critical illness claim for permanent total disability made near the end of their 25-year policy term in January 2023. Mr M had suffered a back injury in 2000 and had not worked since. Standard Life requested medical reports from both the GP and consultant; Mr M refused consent for the GP report but a consultant report was eventually provided in January 2024 showing very limited function but inconclusive statements about permanent disability and future work capacity. The ombudsman found Standard Life's request for the GP report was reasonable and their conclusion that the policy definition had not been met was fair based on the available evidence, particularly given the consultant report's lack of clarity about the position at policy end date and its inconclusive nature regarding permanence.
The Ombudsman's reasoning
The ombudsman considered whether Standard Life's decision was fair and reasonable rather than substituting their own judgment on the claim. The policy definition requires proof that Mr M was completely unable to do any type of work and that this disability would be permanent. The consultant report, although showing very reduced function in January 2024, did not clearly establish the position at the policy end date in January 2023, made no reference to the prior year's position, indicated ongoing investigations, and answered 'unknown' to whether recovery and return to work was possible. Standard Life's request for the GP report was reasonable given the inconclusive nature of the consultant's report. The ombudsman found it was not unreasonable for Standard Life to conclude the policy definition had not been met based on available information.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Phoenix Life Limited, trading as Standard Life, all decisions | 7 | 14% |
Source
Read the original decision on the Financial Ombudsman Service website