Not upheld: claim declined - lack of reasonable prospects of success and incidents outside policy period complaint against Financial & Legal Insurance Company Ltd

Decision detail

Summary

Mr E complained that Financial & Legal Insurance Company Ltd unfairly declined his claim for legal expenses insurance cover to pursue a negligence case against a barrister (Mr C). Mr E had a policy running from November 2020 to November 2021 and made a claim in August 2021, which was declined based on legal advice that the claim lacked reasonable prospects of success. When Mr E provided a favourable barrister's opinion in February 2024, Financial & Legal reconsidered the matter by referring it to its panel solicitors. The solicitors confirmed their original advice, noting that almost all events in dispute occurred in 2019 or earlier, before the policy period began. The ombudsman found the decision was fair and in line with policy terms, as insurance covers future risk not past events, and the claim lacked reasonable prospects of success.

The Ombudsman's reasoning

The ombudsman applied the policy terms requiring that claims concern incidents occurring during the policy period and have reasonable prospects of success. Although Mr E provided a favourable barrister's opinion in 2024, the ombudsman found it reasonable for Financial & Legal to refer this to its panel solicitors for clarification. The solicitors' analysis showed that virtually all events pre-dated the policy start date of 22 November 2020, with most occurring in 2019 or earlier. The only potentially covered matter (an opinion from June 2021) did not require counsel's opinion according to the solicitors' advice. The ombudsman was satisfied the decision was fair and in line with policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website