DRN-6309781

The complaint Mrs I complains that Admiral Insurance (Gibraltar) Limited (Admiral) unfairly settled her motor insurance claim. What happened Mrs I has a motor insurance policy, underwritten by Admiral. In July 2023, Mrs I was involved in a motor traffic accident with a third-party and so she claimed under her policy, and informed Admiral that she didn’t consider herself to be the liable party. Admiral originally pursued the claim as a “non-fault” accident but ultimately settled the claim on a split liability basis. Unhappy with Admiral’s decision, Mrs I complained. Admiral upheld the complaint in part, as it recognized there had been some service failings. However, it didn’t uphold Mrs I’s concerns about its liability decision as it was satisfied it had acted fairly in the circumstances. As Mrs I remained unhappy, she referred her complaint to this Service. Our Investigator didn’t uphold the complaint. They thought Admiral had reached its liability decision fairly, based on the available evidence, and in line with the terms of its policy. Mrs I disagreed and asked for an Ombudsman to make a final decision. In summary, she said the Investigator’s summary didn’t reflect the evidence she had submitted, and the third-party’s account wasn’t possible. Mrs I added that Admiral’s own notes confirmed it hadn’t found her to be liable initially, and Admiral failed to obtain CCTV in a reasonable time frame. Mrs I also said that Admiral’s actions had a profound effect on her and caused significant distress and inconvenience. So, the case has been passed to me to decide. 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. I’ve summarised the circumstances of this case in less detail than presented. But I want to assure both parties that I’ve carefully considered all the information provided. I may not comment on each point raised – and this isn’t intended as a discourtesy. But my decision will focus on the issues I consider to be key to this complaint. While I recognise Mrs I will be disappointed with my decision, I don’t uphold this complaint. I’ll explain why. The scope of my decision I should first set out what I have considered as part of my decision. Mrs I has raised several complaint points over the lifetime of her claim with Admiral. However, Mrs I has previously referred a complaint to this Service about her car’s valuation, failure to obtain CCTV footage, and claim handling up to July 2024 – which was considered previously.

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As these points have previously been considered, I won’t comment on them within my decision. So, what is left for me to decide is whether Admiral treated Mrs I fairly when it reached its liability decision on her claim. The policy terms and conditions The starting point with any insurance claim is the policy terms as this sets out the basis of cover between an insurer and its policyholder. Under the terms of this policy, Admiral has the right to conduct the investigation, defence and settlement of any claim on its policyholder’s behalf. So, under a strict application of the policy terms, Admiral can decide how best to settle a claim. This may mean it reaches a decision its policyholder disagrees with. However, any decision reached should be fair and reasonable, taking into account all the available evidence. Did Admiral decide the claim fairly? Relevant regulatory rules say firms must handle claims promptly and fairly. It isn’t for me to decide who was responsible for an accident – as this is something that can only be determined by the Courts. Instead, I need to determine whether Admiral has decided Mrs I’s claim fairly. In support of the claim, Mrs I provided her own testimony, details of a witness (who was a passenger in her car at the time of the incident), as well as photos of the road, and diagrams of the incident. Based on this evidence, Admiral initially looked to defend the claim on a non- fault basis. However, the third-party insurer responded to this with their own testimony of the incident – which contradicted Mrs I’s. However, the third-party insurer offered to settle the claim on a 50/50 split liability basis. I appreciate Mrs I has maintained that she wasn’t the responsible party for the incident – and has provided detailed accounts of what happened. However, her account alone isn’t sufficient to enable Admiral to defend the claim in the Courts, as the third-party insurer would also be reliant on the testimony of the third-party. As both parties to the claim disputed the circumstances of the incident, Admiral would need to have clear evidence to support its position, such as CCTV or dash-cam footage. I understand Mrs I is unhappy Admiral failed to obtain CCTV footage in a reasonable time frame, but as I have explained above, I won’t be considering the delay in doing so as this has previously been considered. I understand Mrs I feels strongly that CCTV footage could have resolved the dispute. However, regardless of how that issue arose, the position I must consider now is that no such independent footage is available, and Admiral had to make its decision based on the evidence it had at that time. The evidence doesn’t confirm with any certainty how the incident occurred. So, I don’t find it unreasonable for Admiral to conclude there was insufficient evidence to defend the claim should it go to the Courts. Mrs I provided Admiral with details of a witness, who was present and a passenger in her car. While I do not doubt the witness was giving an honest account, Courts and insurers generally treat passenger evidence with caution, as passengers are closely connected to the driver they are supporting. In the absence of any independent corroboration, I do not find it unreasonable that Admiral concluded this evidence would be unlikely to resolve the dispute.

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It may be helpful to explain that while insurers refer to claims as being recorded as “fault” and “non-fault,” the actual terminology is “bonus disallowed” or “bonus allowed.” The term fault isn’t to suggest that Admiral deems Mrs I to be at fault for the accident but reflects that Admiral has been unable to recover its claim outlay in full from another party, such as a third-party insurer. And so, while I recognise Mrs I feels very strongly that she shouldn’t be held responsible for the collision, I don’t find it unreasonable for Admiral to have recorded the claim this way as it was unable to recover the costs it incurred in settlement of Mrs I’s claim in full from any other party. And as Admiral was liable for 50% of the claim outlay, I agree it was reasonable for it to refund 50% of the policy excess. Mrs I has said that Admiral’s actions have caused her significant upset and worry. I’m sorry to hear of the upset and worry she has described. While I’m empathetic to her circumstances, my role requires me to determine if Admiral has treated her fairly, taking into account the relevant law, industry rules and best practices, as well as all the available evidence. And for the reasons I have explained above, I’m satisfied it has here. I therefore do not uphold this complaint. My final decision My final decision is that I do not uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mrs I to accept or reject my decision before 25 May 2026. Oliver Collins Ombudsman

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