Partially upheld: death benefit claim denial and inadequate claims handling complaint against Great Lakes Insurance UK Limited

Decision detail

Summary

Mr G claimed a death benefit on a travel insurance policy following the unexpected death of Mrs C while on holiday. Great Lakes declined the claim as it was unclear whether Mrs C's death resulted from an accident or natural causes. The ombudsman found that Great Lakes reasonably concluded the available evidence did not support an accidental death meeting the policy definition. However, the complaint was partially upheld because Great Lakes failed to communicate clearly, provide adequate support to Mr G, or separate the claim elements, causing unnecessary distress. The ombudsman directed Great Lakes to pay £175 compensation and provide reasonable assistance in obtaining further information.

The Ombudsman's reasoning

The ombudsman found that Great Lakes reasonably concluded the available evidence did not support that Mrs C's death was caused by a violent, sudden and external cause at an identifiable time and place, as required by the policy. It was appropriate for Great Lakes to seek independent evidence to distinguish between death from a fall versus natural causes. However, Great Lakes failed in their duty to communicate clearly, support Mr G adequately, and separate the claim elements, causing unnecessary distress during an already difficult time.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website