Not upheld: claim handling and assessment of prospects of success complaint against Aviva Insurance Limited

Decision detail

Summary

Dr C claimed under his legal expenses insurance policy with Aviva for an employment dispute involving unfair dismissal and discrimination. Aviva's panel firm (Firm A) assessed the claim and concluded it lacked reasonable prospects of success, leading Aviva to decline coverage. After an initial ombudsman decision upheld Aviva's handling, Dr C provided additional evidence from a preliminary hearing and asked for reassessment. Aviva again instructed Firm A to review the evidence, which maintained its original assessment. Dr C complained that Firm A had acted impartially and that the same firm should not have been used for reassessment. The ombudsman found Aviva's actions reasonable and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman found it fair and reasonable for Aviva to instruct Firm A to reassess the claim based on new evidence from the preliminary hearing, as this is a standard practice in claims handling. The policy terms allow Dr C to obtain his own lawyer's opinion if he disagrees, which he had not done. The ombudsman was not persuaded that using the same firm created unfairness, as the supervising person was suitably qualified. No evidence of conflict of interest was found that would have adversely impacted the impartiality of the assessment.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website