DRN-6236403

The complaint Mr L is unhappy with what AmTrust Specialty Limited did following a claim on his legal expenses insurance policy. What happened In March 2025 Mr L sought assistance from his policy with a claim against the governing body of a sport which had refused his membership application. Amtrust didn’t think his claim was covered. In particular, although the policy did cover costs to pursue a legal action following a breach of contract for buying goods or services, Mr L didn’t have a contract with the governing body. It didn’t think his claim was covered by any of the other insured events the policy contained which in any case excluded claims for judicial review. It didn’t agree the legal helpline had told Mr L his claim would be covered. Our investigator agreed Mr L didn’t have a contract with the governing body and thought Amtrust acted reasonably in saying his claim wasn’t covered. She also agreed the exclusion for judicial review applied. She didn’t think Mr L had been told his claim would be accepted when he spoke to the legal helpline. Mr L didn’t agree. He outlined the background to his claim and said he had a clear and reasonable expectation his membership would be confirmed. But it had been denied outside of the published framework and there was an arguable contractual and pre-contractual dispute here. In any event the policy covered employment disputes. He’d previously been employed by the governing body and his claim (which involved unlawful data processing and discriminatory treatment) should have been considered under this section of cover. Amtrust hadn’t done so or asked him for evidence of that previous employment. And the legal helpline had told him there was a legal basis to pursue the matter on other grounds than judicial review (which he accepted was excluded). He said Amtrust should have sought legal advice on whether its interpretation of the policy wording was correct. So I need to reach a final 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. The relevant rules and industry guidelines say Amtrust has a responsibility to handle claims promptly and fairly. It shouldn’t reject a claim unreasonably For cover to be available for Mr L’s claim it needs to fall within one of the insured incidents set out in his policy. The onus is on a policyholder to show their claim falls within one of those sections. If they’ve done that it’s then for the insurer to show, on balance, that an exclusion or condition applies which means it can turn down an otherwise valid claim. Here Amtrust considered whether Mr L’s claim would fall within the ‘Contract’ section of the policy. That covers “costs to pursue or defend a legal action following a breach of contract you have for…buying or renting goods or services for your private use”.

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I understand Mr L would pay a fee for membership of the governing body and that would enable him to access services such as coaching, competing, safeguarding, and insurance. So if he’d entered into that contract a dispute about it might be something which would fall within this insured event. The difficulty for Mr L is that a contract generally comes into existence where the key criteria for it to be formed have been satisfied. Those are offer, acceptance, consideration, intent to create legal relations and capacity. In this case Mr L’s dispute stems from the fact the governing body didn’t accept his membership application. I’ve reviewed what he refers to as the ‘factual matrix’ in relation to this. I appreciate he may well have had an expectation his application would be approved. But taking into account the criteria I’ve outlined for a contract to be formed I think it was reasonable for Amtrust to conclude he hadn’t entered into a contract here; whatever verbal representations may have been given to Mr L during this process it’s clear his membership application wasn’t in fact accepted. Mr L has referred to this as being a pre-contractual dispute. But even if he’s right about that the insured event under his policy refers to a “contract you have”. A pre-contractual dispute where the contract wasn’t entered into wouldn’t therefore be covered. And while Mr L has suggested that in refusing his application the governing body was in breach of contracts it held with other organisations those aren’t contracts he entered into and wouldn’t fall within the insured event his policy contains either. Mr L says Amtrust should have sought legal advice in support of its interpretation of the policy. I don’t think that’s something it needed to do in this case. The interpretation Amtrust has placed on the wording appears reasonable to me and I don’t think it acted unfairly in deciding that meant the claim Mr L made wasn’t covered under this section. It’s for Mr L to show an insured event has taken place so if he disagrees the onus would be on him to provide a legal opinion which evidences he did have a contract with the governing body. In response to our investigator Mr L said Amtrust should have considered whether his claim was covered under the employment disputes section of the policy. The policy does insure “standard advisers’ costs to pursue a legal action against an employer, prospective employer or ex-employer, arising from a dispute relating to your contract of employment or related statutory rights”. It defines ‘contract of employment as “a contract of service, whether express or implied, and (if it is express) whether oral or in writing”. If Mr L had a contract of employment with the governing body which met that definition and the claim he wanted to pursue (including his concerns about unlawful data processing and discriminatory treatment) arose from that contract this is something which might fall within this insured event. However, it’s not clear whether there is a connection between any contract of employment he did have and the refusal of his membership application; I understand his role with the governing body ended around 2015 which was ten years prior to his membership application being made. In any case when making his claim Mr L didn’t tell Amtrust he was a former employee of the governing body (he only referenced in passing that he was previously a director). And he didn’t suggest to Amtrust his claim should be covered by the insured event relating to employment disputes. In the absence of information about that I don’t think there was any reason for Amtrust to think this might apply to his circumstances. So I don’t think it was at fault in not considering his claim under this section. But I’d expect it to do so if Mr L is able to provide further evidence showing both that he had a contract of employment with the governing body and that this dispute relates to that. Mr L also says the legal helpline which he contacted prior to making his claim told him he did have a viable claim on grounds other than judicial review. I’ve listened to those calls. The

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focus is on Mr L’s wider concerns about the governing body and action he thinks other supervisory organisations should have taken in response to that (and haven’t). The general advice is that judicial review would be the best method of pursuing those issues once Mr L had completed any internal processes with the bodies concerned. But it is made clear to him that’s likely to be expensive and something which his policy probably won’t cover. Mr L wasn’t given any indication during these calls his policy would assist with a claim against the governing body in relation to his membership application. For that to be the case it would need to fall within one of the insured events the policy covers. As I’ve explained the onus is on Mr L to show that’s the case and I think it was reasonable of Amtrust to conclude that, to date, he hadn’t done so. Mr L did focus in his helpline calls on his wider concerns about the actions of other supervisory organisations but I don’t they would fall within any of the insured events the policy covers either. In any event it specifically excludes “any claim arising from or relating to…an application for judicial review” which both the legal helpline and Mr L agreed would be the only legal route to progress these claims. My final decision I’ve decided not to uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr L to accept or reject my decision before 14 May 2026. James Park Ombudsman

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