Not upheld: Motor insurance, claim handling complaint against Aviva Insurance Limited

Decision detail

Summary

Ms B complained that Aviva unfairly declined her legal expenses insurance claim for a dispute with her neighbour over noise, smoke, and alleged property damage. Aviva's panel solicitors assessed the claim as unlikely to succeed, leading to the decline. During the complaint process, Aviva offered to obtain a barrister's assessment but Ms B objected to the solicitors' involvement in appointing the barrister, citing her professional negligence complaint against them. The ombudsman found Aviva's reliance on the solicitor's assessment was reasonable as it was properly reasoned and supervised by a qualified professional. The ombudsman also found Aviva's offer to obtain a barrister's assessment was fair and the proposed process, which allowed Ms B to agree to the barrister's appointment and provide submissions, was transparent and reasonable. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found it reasonable for Aviva to rely on the solicitor's assessment because it was properly reasoned, supervised by a qualified solicitor specialising in property matters, and contained no obvious material factual errors. The ombudsman distinguished between disagreement with legal interpretation (which is not an error) and factual errors. The policy condition requiring reasonable prospects of success is common and not inherently unfair. The ombudsman found Aviva's offer to obtain a barrister's assessment went beyond its obligations and the proposed process was fair and transparent, allowing Ms B to agree to the barrister's appointment, provide submissions, and review instructions before they were sent. The ombudsman rejected arguments that M's involvement created unfair barriers or foreseeable harm, noting the barrister would be independent and Ms B would have adequate opportunity to make representations.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website