Not upheld: unfair claim decline complaint against Inter Partner Assistance (IPA)

Decision detail

Summary

Ms D claimed under her legal expenses insurance policy for a property dispute against her neighbour. IPA's appointed panel solicitors assessed the claim and concluded it did not meet the policy requirement of reasonable prospects of success (51% or above), leading IPA to decline the claim. Ms D complained that IPA had unfairly outsourced claims handling and that the panel firm lacked suitable qualifications. The ombudsman found that outsourcing is standard practice, the legal assessment was properly reasoned and not obviously wrong, and IPA fairly relied on the panel solicitor's advice. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that outsourcing claims handling and legal assessments to panel firms is common practice and complies with regulations. The policy terms explicitly permit prospects assessments to be carried out by appointed representatives. The legal assessment was properly written, well-reasoned, and not obviously wrong, having been carried out by a paralegal supervised by a qualified solicitor. As long as an insurer obtains advice from suitably qualified lawyers, the ombudsman will not question reliance on that advice unless it is obviously wrong or based on factual mistakes. The burden is on Ms D to obtain a contrary legal opinion or provide the evidence requested by the panel solicitor if she wishes to challenge the decline.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website