Not upheld: Other regulated complaint complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mr P applied for a life and critical illness policy with L&G in 2024 and 2025, but both applications were declined based on his medical history. After L&G upheld their decision on complaint, Mr P brought the matter to the Financial Ombudsman Service, arguing his medical records should have been assessed in the wider context of his overall functioning and stability. The ombudsman reviewed L&G's underwriting evidence and found the assessment was thorough and applied consistently with their underwriting approach. The ombudsman did not uphold the complaint, finding that L&G had not treated Mr P unfairly or differently from others with similar medical profiles.

The Ombudsman's reasoning

The ombudsman acknowledged that insurers have commercial discretion to decide which risks to cover, but must treat customers with similar risk profiles consistently. The ombudsman reviewed L&G's underwriting approach in detail and found it was thorough and applied consistently. The decision to decline was in line with L&G's underwriting approach and Mr P was not treated differently from others with the same medical history. It is not the ombudsman's role to dictate how insurers should assess risk or determine policy eligibility.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website