Upheld: Home insurance claim disputes complaint against Bastion Insurance Company Limited
Financial Ombudsman decision DRN-5225756 of 2024-12-20T00:00:00+00:00. Home insurance claim disputes complaint against Bastion Insurance Company Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-5225756 |
|---|---|
| Decision date | 2024-12-20T00:00:00+00:00 |
| Firm | Bastion Insurance Company Limited |
| Product | Other regulated product |
| Claim type | Home insurance claim disputes |
| Outcome | Upheld |
| Remedy | Bastion Insurance Company Limited must: (1) reconsider the claim in line with the remaining policy terms, explaining to Miss C what information is needed and considering any information provided before making its decision; (2) pay £100 compensation for the distress and inconvenience caused to Miss C. |
Summary
Miss C claimed on her pet insurance policy for veterinary treatment her dog received in December 2023 after swallowing something harmful. She submitted the claim in March 2024, three months after the incident, breaching the policy's 48-hour reporting requirement. Bastion rejected the claim citing the late notification. The ombudsman found this rejection unfair because the delay caused Bastion no prejudice and it had not properly considered the claim before rejecting it. The ombudsman upheld the complaint, directing Bastion to reconsider the claim on its merits and pay £100 compensation for the distress caused.
The Ombudsman's reasoning
The ombudsman applied ICOBS rules which require insurers to handle claims promptly and fairly and not unreasonably decline claims. Under ICOBS, an insurer cannot reject a claim for breach of condition unless the circumstances are connected to the breach and the insurer can show prejudice. The ombudsman found that the three-month delay in reporting did not cause Bastion any prejudice as it was still able to consider the claim in the same way as if it had been made in December. Therefore, rejecting the claim solely on the basis of late notification was unfair. The ombudsman also noted that Bastion rejected the claim without properly considering it, which caused distress to Miss C.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Bastion Insurance Company Limited, all decisions | 77 | 72% |
| Home insurance claim disputes, all decisions | 25,670 | 38% |
| Other regulated product, all decisions | 47,871 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website