DRN-6281727

The complaint Miss K is unhappy that Liverpool Victoria Financial Services Limited have declined a claim she made on her income protection policy. What happened Miss K made a claim on an income protection policy. LV declined the claim. Miss K appealed the decision but LV’s position on the claim didn’t change. They maintained their view that Miss K’s absence was due to workplace stress and declined the claim. Miss K made a further complaint to the Financial Ombudsman Service. Our investigator looked into what happened. She didn’t think LV had acted unreasonably when declining the claim, considering the available evidence. Miss K didn’t agree and asked an ombudsman to review the complaint. In summary, Miss K felt the medical evidence and other information that had been provided supported that she had a valid claim under the policy. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. The relevant rules and industry guidelines say that LV have a responsibility to handle claims promptly and fairly. And they shouldn’t reject a claim unreasonably. The policy terms and conditions say that there is cover if the insured person can’t work due incapacity caused by an illness or an injury. Miss K has ‘own occupation’ cover. That means in order to meet the policy definition of incapacity she needs to meet the following definition in the policy terms: ‘… because of an accident or sickness, you are unable to do your usual occupation. You would not be expected to go back to work in a different occupation – for as long as you are unable to do your usual occupation, the policy will continue to pay out.’ I’m not upholding Miss K’s complaint because: • It’s for Miss K to demonstrate that she has a valid claim under the policy. It’s not for LV to prove she doesn’t. I’m not persuaded that Miss K has demonstrated she had a valid claim under the policy. • I think LV reasonably concluded that Miss K was absent from work due to situational workplace issues. That’s consistent with the contemporary medical evidence which consistently referred to ongoing workplace issues as being the cause of her absence. Therefore, I think they fairly concluded the barrier to Miss K was workplace issues, rather than illness.

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• Stress generally isn’t considered to be an illness. That’s reflected in lots of medical information that’s available in the public domain, including the NHS website. And most income protection insurance policies wouldn’t offer cover for claims like Miss K’s. • Miss K highlighted that she also experiences anxiety. I’m satisfied this was considered as part of LV’s review. But, as I’ve outlined above, I think they fairly concluded the main reason Miss K wasn’t able to return to work was because of workplace issues. • I’ve considered what Miss K has said about the premiums being refunded as she’s been unable to claim. However, LV has carried the risk of Miss K making a valid claim since the policy was taken out. She had the benefit of cover and, whilst it’s unfortunate she couldn’t claim for this issue, she would have been able to make claims for other health issues. So, I’m not persuaded it’s fair for the premiums to be refunded. For the same reasons I don’t think there’s any reason to direct LV to pay Miss K compensation. My final decision I’m not upholding this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Miss K to accept or reject my decision before 22 May 2026. Anna Wilshaw Ombudsman

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