When Anthony was bitten by a dog abroad, his insurer’s solicitors said that the cost of the case would exceed any amount awarded. He contacted us to make sure a fair decision was being made.
What happened
Anthony was on holiday abroad and was bitten by a dog. He wanted to make a claim against the dog’s owner for compensation for the physical and mental trauma he had experienced. He put in a claim to his insurers so he could get the legal fees for this covered.
But his policy excluded any claim the insurer or its legal representatives believed:
- wasn’t likely to be successful
- the costs of taking action would be more than any award
The insurer got a legal opinion on the prospects of success of the claim from its panel firm. The legal opinion was that a claim against the owner was unlikely to succeed and the prospect of recovering costs was remote. And it was likely that legal costs would be far more than any amount recovered so it wouldn’t be proportionate to pursue.
The insurer declined the claim based on the exclusion. Anthony felt the outcome was unfair and complained the insurer. Unhappy with its final response, he contacted our service to make a complaint.
What we said
When we looked at the evidence of the situation, we had some questions about the legal opinion. It hadn’t provided any reason for why the claim was unlikely to be successful. There also wasn't any comment made on the law of the country where the incident happened. It also appeared to us that the lawyer hadn't seen the policy terms.
We made the decision to ask the insurer to get a more detailed legal opinion, clearly showing why the claim was unlikely to succeed. We also told the insurer that they would need to let Anthony know whether this affected their decision.