Not upheld: Travel / life insurance claim disputes complaint against Astrenska Insurance Limited

Decision detail

Summary

Mr S claimed on his personal accident insurance policy following a June 2023 road traffic accident, seeking payment for permanent and total disability. Astrenska declined the claim, and a previous FOS complaint in July 2025 was not upheld. Mr S submitted new medical evidence (neurologist, psychiatric, and pain medication reports) arguing he now met the policy criteria. The ombudsman found that while the new evidence documented chronic back pain and mental health issues, it failed to establish that his injuries resulted 'solely and independently' from the 2023 accident, as required by the policy definition. Medical records showed Mr S had suffered similar symptoms from previous accidents in 2010 and 2017, establishing multiple causes for his condition. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy definition of bodily injury requires injury to result 'solely and independently' from an accident. The new medical evidence, while documenting chronic back pain and poor mental health following the 2023 accident, did not persuade the ombudsman that Mr S's injuries were independently caused by that accident. The medical records clearly showed Mr S had suffered from back, neck, hip and leg pain symptoms prior to 2023 as a result of previous accidents in 2010 and 2017. Although the symptoms likely worsened after the 2023 accident, the evidence demonstrated multiple other causes for his condition, meaning the bodily injury requirement was not satisfied.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website