Aviva denies man HIV payout over blood transfusion clause
A man who made a health insurance claim after testing positive for HIV was denied a payout because of the way he contracted the virus.
The man, known only as Mr C, said he was infected after receiving medical assistance on holiday. He subsequently lodged a claim via the critical illness policy he had taken out.
However, Aviva decided he didn't meet its criteria for how the virus was transmitted and refused to pay out.
Mr C and his wife then complained to the Financial Ombudsman Service, but it ruled against them.
The couple took out a life and critical illness policy with Aviva in 2017, then made the claim after Mr C was diagnosed with HIV last year. He said he had contracted the condition during medical investigations and treatment while on holiday.
The policy did list HIV as a critical illness, but only paid out when it was contracted as part of a blood transfusion, a physical assault or an accident at work. It also stated that 'HIV infection resulting from any other means, including sexual activity or drug misuse' was not covered.
After assessing Mr C's claim, Aviva declined to pay out, as records showed he did not receive a blood transfusion.
He then went to the Ombudsman, but after examining the evidence, it rejected his case and a subsequent appeal.
'Complex and inconsistent' rules
Lindsey Ponsonby, of the National AIDS Trust, said her organisation regularly heard from people living with HIV who faced barriers to accessing financial services and insurance.
She said: 'These cases highlight how complex and inconsistent the rules can be. We are particularly concerned by the way transmission routes are categorised, which only serve to reinforce outdated and harmful distinctions between so-called 'innocent' and 'non-innocent' modes of transmission.
'This decision highlights a case that falls squarely between the cracks – where rigid rules fail to reflect the realities of people's lives. The outcome is clearly unfair and underscores the urgent need for more inclusive and evidence-based policies.'
The Association of British Insurers provides minimum standards for what a critical illness policy must include, alongside model wording for insurance companies to use. Cancer, heart attack and stroke are covered by all policies.
In 2014, it released guidance that included wording on HIV, which was used in Mr C's policy with Aviva.
However, the association removed this in 2018, enabling firms to adopt the wording they considered appropriate. It also said that medical advancements meant that some conditions, including HIV, could no longer be considered 'critical' in terms of life expectancy.
Aviva paid out £389m in critical illness claims in 2024, but its policies no longer cover HIV.
A spokesman for the insurer said he could not comment on specific cases without the customer's permission.
He added: 'In 2018, the Association of British Insurers removed HIV from its minimum standards for critical illness. Aviva removed HIV as a condition on its new policies following this guidance to the industry.
'On our policies underwritten in 2017, cover for HIV was provided where the condition was as a result of a blood transfusion, a physical assault or an accident at work.
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