Not upheld: Other regulated complaint complaint against Inter Partner Assistance SA

Decision detail

Summary

Miss A claimed under her travel insurance policy's legal expenses cover after being injured in a slip at an airport. IPA initially declined the claim without detailed assessment, but following FOS investigation, instructed solicitors to conduct a full prospects assessment. The solicitors and overseas Counsel concluded the claim lacked reasonable prospects of success due to insufficient evidence. The ombudsman upheld IPA's decision to decline the claim as fair, finding the policy terms require reasonable prospects of success and IPA properly relied on qualified legal advice. IPA was ordered to pay £100 compensation for poor communication and delays.

The Ombudsman's reasoning

The ombudsman found that IPA acted fairly in declining the claim because it obtained advice from suitably qualified and experienced lawyers who concluded the claim lacked reasonable prospects of success. The policy terms clearly state cover is only provided where claims are more likely than not to be successful. Although Miss A argued the lack of CCTV footage was outside her control, the policy terms make clear that cover depends on likelihood of success in court, not on the availability of evidence controlled by third parties. The ombudsman will not generally question an insurer's reliance on qualified legal advice unless it is obviously wrong or based on obvious factual mistakes.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website