Upheld: Travel / life insurance claim disputes complaint against WDP Insurance Limited

Decision detail

Summary

Mr T claimed losses of two mobile phones on 26 March 2022 under two WDP insurance policies. WDP discovered that the SIMs had been used in different phones the day before the claims were made, which contradicted Mr T's initial statements about phone usage. WDP declined both claims and cancelled the policies citing 'potentially fraudulent activity'. Mr T complained, explaining he could not recall details when questioned 17 days later and that the policy terms did not prohibit SIM usage in different devices. The Ombudsman upheld the complaint, finding that while discrepancies existed, WDP had not fairly established fraudulent intent and must reinstate and reassess the claims in line with the policy terms and conditions.

The Ombudsman's reasoning

While the Ombudsman acknowledged discrepancies between what Mr T told WDP and the usage reports, the reason WDP presented for declining the claims was not fair in the circumstances. Mr T's inability to recall details when questioned 17 days after the incident, combined with the absence of call recordings and the limiting nature of call notes, does not fairly support a finding that Mr T more likely than not made fraudulent claims. The policy terms do not prohibit using SIMs in different devices, and Mr T did disclose using a previous mobile and had not denied the existence of other mobiles. The Ombudsman found WDP's enquiries were warranted but their conclusion to decline the claims based on discrepancies in Mr T's recollection was not sufficiently supported.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website