Upheld: claim declined - date of incident exclusion complaint against Accredited Insurance (Europe) Ltd

Decision detail

Summary

Ms A held legal expenses insurance with Accredited from January 2022 and made a claim in 2024 relating to a neighbour dispute about a tree. Accredited declined the claim on the basis that the original incident occurred in December 2021, before the policy commenced. The ombudsman upheld the complaint, finding that Ms A could not reasonably have known a claim would be necessary in December 2021 when she merely reported the issue to the management company. Additionally, even if that date were accepted, fairness would require Accredited to consider the claim, as Ms A had continuous cover and her claim would otherwise fall between her previous 'claims made' policy and Accredited's 'claims occurring' policy, leaving her with no cover.

The Ombudsman's reasoning

The ombudsman found that Ms A ought not reasonably to have known in December 2021 that a dispute or claim would arise, as the management company had confirmed it would pass the issues to the neighbour with no indication of failure to act. The date of incident should be when the neighbour's position became known, which was after Accredited's policy commenced. Additionally, even if the December 2021 date were accepted, fairness and the FCA principle of treating customers fairly would require Accredited to consider the claim, as Ms A had continuous cover and her claim would otherwise fall between two stools - neither the previous 'claims made' policy nor Accredited's 'claims occurring' policy would cover it.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website