Not upheld: claim decline based on policy exclusion complaint against Accredited Insurance (Europe) Limited

Decision detail

Summary

Mr M complained that AIL unfairly declined his claim under the Property Owner's Liability section of his home insurance policy when his wife Mrs M was injured at home. AIL relied on a policy exclusion covering injuries to family members. Mr M argued that AIL should have made an exception given his and Mrs M's vulnerabilities and their circumstances as carer and care recipient. The ombudsman found that AIL acted fairly and within policy terms by applying the exclusion, as Mrs M was Mr M's wife and permanent resident. While the ombudsman acknowledged the vulnerabilities and financial impact, it determined that regulatory principles do not require insurers to accept claims outside their policy coverage. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that AIL acted within the policy terms and conditions by applying the family member exclusion to Mrs M. While acknowledging Mr M's vulnerabilities, the ombudsman determined that Consumer Duty and Treating Customers Fairly principles do not require insurers to accept claims outside their policy coverage. The ombudsman was satisfied that AIL took reasonable steps to adapt their processes by referring the claim to lead underwriters and appropriately considered Mr M's circumstances. The exclusion was clearly worded, not unusual, and aligned with industry standards.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website