Not upheld: Travel / life insurance claim disputes complaint against Scottish Widows Limited

Decision detail

Summary

Mr L held critical illness insurance with Scottish Widows since 2010 and claimed in March 2025 after discovering he had suffered a stroke. The stroke was identified following an MRI scan undertaken for memory problems, which revealed chronic lacunar infarcts and small vessel disease. Scottish Widows declined the claim because it could not determine when the stroke occurred, noting that Mr L had pre-existing conditions (high blood pressure and memory issues) dating to 2006 that predated the policy. The ombudsman upheld Scottish Widows' decision, finding that without objective medical evidence proving the stroke happened after August 2010, the firm reasonably declined the claim.

The Ombudsman's reasoning

The ombudsman found that while Mr L had suffered a stroke, there was no objective medical evidence establishing it occurred after the policy inception in August 2010. The medical evidence showed pre-existing conditions from 2006 that could have led to the stroke prior to the policy start. The MRI findings were consistent with changes occurring over many years, and neither the stroke clinic consultant nor Scottish Widows' Chief Medical Officer could determine when the stroke occurred. Without evidence proving the stroke happened within the policy period, Scottish Widows could reasonably decline the claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website