Summary: We will not investigate this complaint about a personal injury claim because the courts are better placed to consider the complaint and it is reasonable to expect Mrs Y to go to court about the matter.

The complaint

1. Mrs Y complained the Council has wrongly rejected her claim for personal injury against its insurance. Mrs Y says she feels she has been made out to be a liar and feels the situation is unfair.

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The Ombudsman’s role and powers

2. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)
3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is another body better placed to consider this complaint. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

4. I considered information Mrs Y and the Council provided and the Ombudsman’s Assessment Code.

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My assessment

5. Mrs Y has asked us to investigate how the Council’s insurer has considered and responded to her personal injury claim against it after she fell and was injured while on a council-maintained road.
6. The legislation from which the Ombudsman takes their power also places some restrictions on what we may investigate. One of these concerns negligence claims about damage to property or personal injury. We cannot determine liability claims for negligence. These are legal claims which may only be determined by insurers or the courts.
7. We are not able to decide liability or award damages Mrs Y says she is aware of this but would like us to consider the reasonableness of the response given and the insurer’s decision-making process when assessing her claim. We could not however form a view on this without taking a position on Mrs Y’s claim and its validity. This is not the role of the Ombudsman and would be for the court to consider.
8. Any claim for damages, such as costs for repairs or for personal injury, which Mrs Y considers the Council to be responsible for, are matters more appropriately dealt with by the courts as they can consider the claim itself, which we cannot, making it better placed to consider this complaint. As the court can make reasonable adjustments if necessary and Mrs Y has given no other indication why she cannot use her right to take the matter to court, it is therefore reasonable for Mrs Y to pursue her claim through the courts. We will not investigate this complaint.

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Final decision

9. We will not investigate Mrs Y’s complaint because the courts are better placed to consider the complaint and it is reasonable to expect Mrs Y to go to court about the matter.

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Investigator's decision on behalf of the Ombudsman