Upheld: Travel / life insurance claim disputes complaint against Millennium Insurance Company Limited

Decision detail

Summary

Mr S complained about Millenium's handling and decline of his income protection insurance claim based on a pre-existing medical condition exclusion. Millenium declined the claim without requesting medical evidence from Mr S's specialist, despite the GP suggesting this should be done. The ombudsman found insufficient evidence to support the exclusion and that Millenium should have gathered further information, particularly after Mr S expressed unhappiness and provided additional information. The complaint was upheld, and Millenium was directed to reassess the claim and pay £200 compensation for the distress and inconvenience caused by the delay and poor handling.

The Ombudsman's reasoning

The ombudsman found that Millenium bore the onus of proving the pre-existing medical condition exclusion applied, but failed to do so due to insufficient medical evidence. Although insurers should handle claims promptly, they must also do so fairly and not unreasonably reject claims. Millenium should have requested information from Mr S's specialist, especially after he expressed unhappiness and provided additional information. The failure to do so caused delay, stress, and frustration.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website