Not upheld: Travel / life insurance claim disputes complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mr and Mrs W complained that Legal and General unfairly declined a terminal illness claim on their life insurance policy. The claim was made within the final 12 months of the policy, which the policy terms explicitly exclude. Mr W alleged he was told in 2022 he could claim, but did not contact the firm again until 2025. The ombudsman found no evidence of misleading information and no evidence the diagnosis was terminal before the exclusion period began. The ombudsman upheld the firm's decision to decline the claim in line with the policy terms and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman found that Mr W's claim was made within the final 12 months of the policy, which is explicitly excluded under the policy terms. There was no evidence that Mr W was misled about the circumstances in which he could claim, as he received claim forms but did not contact the firm again until 2025. No compelling evidence demonstrated the diagnosis was terminal before the exclusion period began. The ombudsman did not consider it fair and reasonable to direct the firm to pay outside the policy terms given these circumstances.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website