INTACT INSURANCE UK LIMITED · DRN-6224527

The complaint Ms C complains about the way INTACT INSURANCE UK LIMITED dealt with a claim on her legal expenses insurance policy and says its errors affected the progress of her legal case. Where I refer to Intact Insurance, this includes its agents and claims handlers acting on its behalf. Ms C has a representative supporting her with the complaint, but for ease I’ll refer to Ms C throughout. What happened Ms C had a dispute with her employer. They agreed a settlement in 2023 but Ms C did not think the employer was acting in line with the agreed terms and in June 2024 she lodged a grievance. She made a claim on her policy for her legal costs to be covered. Intact Insurance referred the claim to its panel solicitors to assess but in September 2024 they said it did not have prospects of success, which is a requirement under the policy for cover to be given. They reviewed this after Ms C provided further information but didn’t change their view. So cover was not provided. In December 2024 Ms C received the outcome of her grievance and asked the solicitors to review the case but there was no further action at that point. In February 2025 Ms C asked Intact Insurance to reconsider the claim. Intact Insurance said if she wanted to challenge the decline of her claim, she would need to obtain her own legal advice. In May she complained about the way the claim had been handled. Intact Insurance agreed it should have reviewed the claim again and referred it to a barrister. The barrister said the case did now have reasonable prospects of success, so Intact Insurance agreed to provide cover. In its final response to the complaint, Intact Insurance offered compensation of £150 for the distress and inconvenience caused to Ms C. She didn’t accept the offer and referred the complaint to this Service. Our investigator agreed Intact Insurance should have acted more quickly in February 2025, but said it had put things right quickly once she complaint and the compensation of £150 was fair. Ms C disagrees and has requested an ombudsman’s decision. 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. Ms C has disabilities and health issues. Her claim arises out of disputes with her employer relating to this. I appreciate the whole situation has been very difficult for her, but I’m only considering the events addressed in the final response Intact Insurance gave to this complaint in June 2025.

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Many of the points Ms C has asked me to consider relate to events after June 2025, and the legal advice given about the underlying legal dispute. She has asked that I review things on the basis of the different evidence now available, but I can’t comment on that. I can only consider events up to June 2025, and how Intact Insurance dealt with the insurance claim on the basis of the information that was available at the time. And I can’t comment on the actions of the solicitors and barristers involved, or the legal advice they gave. The relevant industry rules and guidance say insurers must deal with claims promptly and fairly; support a policyholder to make a claim and consider if someone is in a vulnerable situation when dealing with them; and not unreasonably reject a claim. They should settle claims promptly once settlement terms are agreed. The policy terms say cover will be provided if the claim has reasonable prospects of success. It’s a requirement of almost all legal expenses insurance that cover will only be provided if a claim is likely to be successful. I think that’s reasonable – it wouldn’t be fair to expect an insurer to cover a claim if it’s unlikely to succeed. Insurers will obtain legal advice about the prospects of success and they’re entitled to rely on that advice unless it’s obviously wrong. They will keep this under review as a case progresses. The panel solicitors assessed the case in September 2024 and said the claim didn’t have reasonable prospects. The solicitors considered possible claims for victimisation, failure to make reasonable adjustments and breach of contract. They reviewed the key facts and relevant law, and explained why they did not think the claims had reasonable prospects of success. In October, the solicitors summarised the additional comments from Ms C and explained why they didn’t think her comments changed their advice. As I’ve explained, insurers are entitled to rely on the legal advice provided, unless it’s obviously wrong. These were reasoned opinions, given by someone suitably qualified and experienced. It was reasonable for Intact Insurance to decline cover based on the advice given. Ms C provided information about the outcome of her grievance to the solicitors in December 2024. They didn’t take any further action, and it seems the relationship between them and Ms C broke down. The solicitors mentioned that Ms C was seeking a further review but she didn’t contact Intact Insurance again until February 2025. The further information showed Ms C had been successful in her grievance. Intact Insurance should have agreed to reconsider the claim – the legal advice had been given on the basis of the information available at the time, but the circumstances had changed. It wasn’t reasonable to tell Ms C to seek her own legal advice. But Intact Insurance has accepted this and said once it was established that the relationship with the panel solicitors had broken down, it should have sought a further assessment from someone else. When Ms C complained, it acted very quickly, getting a positive counsel’s advice within a week, after which a different firm of solicitors was appointed to act. This is what should have happened in February. So there was a delay there between February and May. I’ve considered the impact of that delay. I’m aware the claim has been reviewed again more recently and – while I can’t comment on how that was dealt with – I understand the current position is that it has once again been assessed to not have prospects of success. Ms C says she lost the opportunity to pursue her legal case as a result of failings in the claim. As at May 2025, the advice was that she had reasonable prospects of success and cover was in place. Much of her argument concerns legal advice given later on, which she disagrees with. That’s not something I can consider in this complaint. As I’ve explained, if she is unhappy about events after June 2025, she can make a further complaint about that.

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Looking at the limited period covered by this complaint, what I can say is that the delay in February 2025 made what was already a very difficult time for Ms C even more difficult. But I think the compensation of £150 is a reasonable way to acknowledge the additional distress caused during that short period. Ms C has said the first firm of panel solicitors had a conflict of interest and should not have been dealing with her case. They did not agree they were conflicted, but came to the view that, due to the disagreements between them, the relationship had broken down and they could no longer act. That is ultimately a matter for the solicitors to deal with. Solicitors have their own regulator and are required to act in line with their professional responsibilities. It was for the solicitors to say whether they had a conflict of interest. It wasn’t for Intact Insurance to supervise the solicitors’ actions or the way they dealt with the case, and that’s not something I can review either. Ms C has also said Intact Insurance failed to obtain the panel solicitors’ file before making its decision. I wouldn’t expect an insurer to do this – it’s for the solicitors to obtain and assess the evidence they need, then give their advice. Intact Insurance could then act on the basis of that advice. For these reasons, I think the offer already made is a fair way to settle this complaint. If Ms C remains unhappy about how the claim has been dealt with since June 2025, she may make a fresh complaint about that, which can be considered separately. My final decision INTACT INSURANCE UK LIMITED has already made an offer to pay £150 to settle the complaint and I think this offer is fair in all the circumstances. So my decision is that INTACT INSURANCE UK LIMITED should pay £150. Under the rules of the Financial Ombudsman Service, I’m required to ask Ms C to accept or reject my decision before 27 April 2026. Peter Whiteley Ombudsman

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