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

Decision detail

Summary

Mr B and Mrs P complained about Aviva's handling of a medical expenses claim on their travel insurance policy after Mrs P underwent emergency surgery abroad on 27 July 2025. They were unhappy that the MAT did not immediately confirm cover, felt the initial call handler was unsupportive, and believed the medical team's subsequent interactions were inappropriate. They requested approximately £60,000 in compensation. The ombudsman found that Aviva acted fairly and reasonably throughout, as requiring additional evidence before confirming cover is standard practice, the call handler explained the process clearly, and the medical team handled communications sensitively and appropriately. The complaint was not upheld and no compensation was awarded.

The Ombudsman's reasoning

The ombudsman applied regulatory rules requiring insurers to handle claims promptly and fairly. The ombudsman found that: (1) Aviva responded appropriately to initial contact difficulties by calling Mr B back and connecting him to the MAT; (2) the call handler asked reasonable questions and clearly explained that cover confirmation required additional evidence, which is standard practice for travel insurers; (3) the policy terms explicitly state that Aviva may require further evidence before deciding whether to pay a claim; (4) cover was confirmed within two days on a disclaimer basis, which was prompt; (5) the MAT's medical team handled calls sensitively and asked reasonable questions; (6) there was no evidence the medical team deliberately avoided contacting Mr B and Mrs P; and (7) Mrs P was already undergoing necessary surgery when the initial call was made, so Aviva did not prevent or delay access to treatment.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website