Not upheld: Home insurance claim disputes complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mrs J complained that Legal and General unreasonably delayed assessing her income protection insurance claim and ultimately declined it without sufficient grounds. She had been absent from work since June 2025 due to illness and reported the claim in September 2025. Legal and General made multiple requests for medical information from her GP, which Mrs J felt were excessive and caused unnecessary delays. In February 2026, Legal and General declined the claim, stating there was insufficient medical evidence to confirm she had no capacity to perform her occupation. The ombudsman found that Legal and General's requests for information were reasonable given the incomplete initial records, and that the claim decline was justified because the available medical evidence did not clearly demonstrate Mrs J met the policy's definition of incapacity throughout the required period.

The Ombudsman's reasoning

The ombudsman found that Legal and General's requests for medical information were reasonable because initial records were incomplete with redacted entries and missing specialist correspondence. Each time new information was received, it reasonably prompted further investigation. The decision to request full unredacted medical records from January 2017 onwards was appropriate to assess the claim comprehensively and verify policy disclosures. The claim decline was reasonable because the available medical evidence did not clearly demonstrate that Mrs J was unable to carry out her occupation throughout the deferred period, which is required under the policy definition of incapacity. While hindsight might suggest requesting full records earlier would have been faster, there was nothing early in the claim to necessitate this, and insurers should only request relevant information.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website