Not upheld: claim decline - terminal illness benefit complaint against Liverpool Victoria Financial Services Limited trading as LV

Decision detail

Summary

Mrs H complained that LV unfairly declined her terminal illness insurance claim. The policy required a terminal illness diagnosis (life expectancy less than 12 months) to be made at least 12 months before the policy termination date of 19 May 2026. Mrs H's Consultant first stated her life expectancy was less than 12 months on 6 October 2025, which was after the required deadline of 19 May 2025. LV's Chief Medical Officer reviewed the medical evidence and did not find the terminal illness term was satisfied before the deadline. The ombudsman found LV did not treat Mrs H unfairly by declining the claim, though LV had provided incorrect information. The ombudsman upheld LV's offer of £2000 compensation as fair.

The Ombudsman's reasoning

The ombudsman applied the regulatory requirement that insurers must handle claims promptly and fairly and must not turn down claims unreasonably. The policy terms clearly required a terminal illness diagnosis to be made at least 12 months before the policy termination date of 19 May 2026. The medical evidence showed the diagnosis of life expectancy less than 12 months was first made on 6 October 2025, which was after the required deadline of 19 May 2025. LV's Chief Medical Officer reviewed the evidence and did not find the term was satisfied before this time. Therefore, LV did not treat Mrs H unfairly or unreasonably by declining the claim. The £2000 compensation for incorrect information and time wasted was considered fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website