Aviva Life & Pensions UK Limited · DRN-6196958

The complaint Miss P complains that Aviva Life & Pensions UK Limited (‘Aviva’) have provided conflicting information relating to the criteria for acceptance of her serious ill health claim to enable her to access her pension. She states that this resulted in her GP refusing to sign the required declaration and Aviva have not accepted the claim. Miss P states that she is suffering financial hardship as a result of this. What happened Miss P held a personal pension with Aviva, which at 31 July 2025 was worth approximately £31,867. Having been unable to work for a number of months, sometime prior to September 2025, Miss P decided to access her pension. As she was under the minimum age for taking pension benefits (currently age 55), the only way to do this would be to submit a claim for early retirement on the grounds of ill health. She was sent a claim form, which included a section to be completed by her GP, however, Miss P’s GP declined to sign the claim form. At Miss P’s request, on 2 September 2025, Aviva wrote to her GP to clarify their requirements. The letter stated that Aviva were not asking the GP to confirm that Miss P’s health condition was permanent and irreversible – they were asking for confirmation that she would no longer be able to continue in her current occupation or return to this role in the future. On 29 September 2025, Miss P wrote to Aviva by email. She stated that her GP was refusing to sign her claim form because they believed that the clause relating to permanent and irreversible referred to her medical condition rather than her ability to perform the essential duties of her occupation. She requested that Aviva write directly to the GP to confirm the correct interpretation of the definition and to explain to her GP that they were not being asked to certify that her medical condition was permanent and irreversible and that they were only being asked to confirm that due to her health, she is permanently unable to carry out the essential duties of her occupation. On 2 October 2025, Aviva wrote to Miss P’s GP. They asked for confirmation that Miss P would no longer be able to continue working in her current occupation or continue to this role in the future. On 16 October 2025, Miss P requested an update on progress from Aviva. Aviva responded to confirm that they had her documents however without the confirmation from the GP, they were unable to proceed. On 20 October 2025, Aviva sent an email to Miss P confirming that Current Occupation means that someone is unable to carry out essential duties of their current occupation, ie the one that they have had to give up. This must be permanent and irreversible. On 6 November 2025, Aviva wrote again to Miss P to confirm that ill health retirement means a person can no longer carry out their occupation, and would be unable to work in the future.

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On 13 November 2025 Miss P complained to Aviva because she was unhappy with the conflicting information which had been provided relating to the ill health claim. On 20 November 2025, Aviva provided their final response to the complaint. They confirmed that they had written to Miss P’s doctor on 2 September 2025 asking for confirmation that Miss P would no longer be able to continue working in her current occupation or return to this role in the future. They added that the application form also clarifies what “current occupation” means. Aviva apologised that she was given conflicting information but confirmed that the information provided to Miss P’s doctor was clear and there was nothing further that could be added. They confirmed that the quote Miss P had received was valid for six months and when they received the completed claim form back, they would proceed with the option Miss P chooses. If the quotation expires, Aviva confirmed a new quotation would be provided. By way of apology for the trouble and inconvenience caused, Aviva sent to Miss P a cheque for £100. On 25 November 2025, Miss P’s GP wrote to her following her dissatisfaction that they would not signed the form and referring to a further letter from Aviva which had been forwarded to them by Miss P. This letter stated that the GP was aware that Aviva are referring to Miss P’s current occupation and were not disputing that, however they were unable to confirm at that time that Miss P would not be able to work in her current occupation in the future. They stated that due to the nature of Miss P’s conditions, they could not state that the conditions would permanently prevent her from ever working in her current role again. In early December 2025, Miss P forwarded her complaint to this service and on 9 December 2025, Miss P provided a further update. She reiterated that the conflicting and unclear information provided by Aviva have made her GP believe that they were being asked to certify that Miss P was permanently unfit to perform “this type of work anywhere” which they were not able to do despite her health. She asked this service to consider whether the misleading information has prevented the claim from progressing, and requested whether Aviva can accept the existing medical evidence instead of insisting on the claim form. On 30 January 2025, having carried out an investigation, our investigator provided their view. They concluded that although the information shared by Aviva was confusion, it was corrected quickly, and didn’t have an impact on Miss P’s GP’s ability to assess and complete her claim form. Miss P remained dissatisfied and as a result, her complaint has been forwarded to me for 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. I think it would be helpful to provide some context and background to the rules that underpin why Avia is asking for this information. Under both pension tax legislation and the scheme’s own rules, early access to pension benefits before age 55 is only permitted in very limited and strictly defined circumstances, one of which is ill health. That exception can only be met where a doctor confirms that the member is, in their professional opinion, incapable of continuing in their current employment because of physical or mental impairment. The medical evidence that Aviva needs to rely on is set at a high bar. That’s because the regulator has implemented that statutory safeguard to ensure that benefits paid lawfully and to prevent unauthorised payments which could expose both the consumer and the scheme to significant tax charges. So, whilst Miss P may have found the process frustrating, before Aviva releases any benefits prior to a consumer reaches age 55, they must be completely satisfied that bar has been

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reached so they can demonstrate to the regulator that their decision is robust, fair and compliant with the legal framework governing early pension access. Miss P states that her complaint centres on Aviva’s ill-health pension form, specifically the wording “Unable to carry out the essential duties of your current occupation. This must be permanent and irreversible.” I have reviewed the information provided both to Miss P and her GP. The claim form confirms that the relevant section needed to be completed by a registered medical practitioner in order to satisfy HMRC ill health conditions. These conditions are non- negotiable for pension schemes and providers. The form states that for a patient to be able to take retirement due to ill health they need to meet the ill health condition, which is “where they’re unable to carry out essential duties of their current occupation, ie the one they’ve had to give up. This must be permanent and irreversible.” I have considered whether this is in any way ambiguous and am not persuaded that it is. Miss P states that she has received conflicting information from Aviva, and it is due to this confusion and ambiguity that her GP has refused to sign the claim form. She states that the reason the GP has refused to sign the form is that they believed the wording meant that she could never work again in any future role. Given that it was the GP’s refusal to sign the form that prompted Miss P to request additional information from Aviva (and the incorrect information was not provided until after this initial refusal), I am not persuaded that Aviva’s error was a material factor in the GP refusing to sign the form. The statement outlining the definition of ill health is in no way ambiguous or unclear, and the GP has explicitly confirmed they understood the requirements and the reasons they believe that Miss P’s conditions did not meet these. Miss P states that Aviva initially confirmed verbally that “current occupation” means the job role she had already left, which was supported by an email from Aviva but was subsequently told by a representative of Aviva that the definition meant that she could never work again in any capacity. Miss P states that she requested that a specific Aviva employee was not involved further in her case, however Aviva continued to involve him and he continued to provide incorrect and information which has worsened the confusion and delays. Throughout her correspondence, Miss P asserts her belief that her GP are refusing to sign the claim form to allow her ill health early retirement pension claim to be processed due to Aviva’s conflicting or confusing information. In her correspondence to this service, Miss P states that the letters from her GP practice state that they “cannot confirm” and imply that the form asks them to certify permanent, irreversible capacity. I cannot find evidence to support this assertion. The letters from the GP are clear, in that they understand Aviva’s requirements, but that they cannot confirm that her conditions will permanently cause her to be unable to carry out her current occupation. Having considered the evidence available to me, I am unable to agree with Miss P that Aviva’s conflicting or confusing information caused her GP to refuse to sign the claim form to allow her to access her pension early on the basis of ill health. In their letter of 25 November 2025, Miss P’s GP has clearly stated that they are aware that Aviva are referring to Miss P’s current occupation and were not disputing that. They have clearly advised Miss P that they are unable to state that her current medical conditions would permanently prevent her from ever working in her current role. Therefore, I have concluded that it would not have made any difference whether the correct definition was that Miss P would be unable to work in her

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current occupation or any other occupation – both would require her GP to confirm that her condition was permanent, which they state they are unable to do. Whilst I understand how frustrating it must have been for Miss P to be provided with conflicting information from Aviva, particularly when also liaising with a third party to complete the required forms, it would not be fair of me to hold Aviva responsible for her GP’s views in relation to whether her condition was likely to be permanent and prevent her from working in her current occupation in the future. It therefore follows that I whilst I uphold the element of Miss P’s complaint against Aviva relating to the provision of confusing information, I do not uphold the remainder of the complaint. Miss P has requested that Aviva accepts completion of the form by another doctor, conduct an internal or independent medical assessment, or assess her claim using the evidence already provided documenting her sickness record and long term conditions. It would not be reasonable for me to request Aviva to follow a different process for acceptance of Miss P’s claim. This service isn’t intended to regulate or punish businesses for their conduct – that is the role of the Financial Conduct Authority. Likewise, this service cannot tell a business how to operate or make commercial decisions. Instead this service looks to resolve individual complaints between a consumer and a business. Should we decide that something has gone wrong we would ask the business to put things right by placing the consumer, as far as is possible, in the position they would have been if the problem hadn’t occurred. From the evidence I have received, there is nothing to suggest that without Aviva’s conflicting statements in relation to the criteria to be met in order to accept a claim for ill health early retirement, Miss P’s GP would have been happy to complete the form. I have come to this conclusion because the letters from the GP’s practice confirm that they cannot say that Miss P’s conditions will permanently prevent her from ever working in her current role again. I find there is no scope for ambiguity in this statement, which confirms that Miss P does not meet the regulator’s requirements for Aviva to accept her claim. Aviva have already apologised for their error and paid £100 to Miss P in respect of the trouble and inconvenience caused when a representative provided confusing information. This is in line with what this service would have instructed them to pay for an issue such as this, and therefore I will not be asking them to do anything further. My final decision For the reasons above whilst I am upholding Miss P’s complaint against Aviva Life & Pensions UK Limited, I won’t be asking them to do anything further than what they’ve already offered to do to resolve matters. Under the rules of the Financial Ombudsman Service, I’m required to ask Miss P to accept or reject my decision before 16 April 2026. Joanne Molloy Ombudsman

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