Not upheld: Motor insurance, claim handling complaint against Newline Insurance Company Limited

Decision detail

Summary

Mrs M complained that Newline Insurance Company Limited unfairly applied a £750 cruciate ligament treatment limit to include the cost of diagnostic x-rays, arguing that x-rays should be classified as investigation rather than treatment. Newline had pre-approved the x-rays and subsequently applied the £750 limit to the combined cost of x-rays and the £3,500 operation. The ombudsman found the complaint not upheld, determining that the policy definition of 'treatment' explicitly included x-rays and other investigations, making Newline's application of the limit fair and reasonable.

The Ombudsman's reasoning

The ombudsman found that the policy definition of 'treatment' explicitly includes 'examination, consultation, advice, tests, X-rays, medication, surgery, nursing, prescription diet food and care provided by a veterinary practice'. Since x-rays are specifically listed as treatment and Mrs M's dog was being treated for a cruciate ligament repair, the £750 limit fairly applied to the combined cost of x-rays and the operation. Mrs M's argument that x-rays were investigation rather than treatment was rejected based on the clear policy wording.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website