Not upheld: Travel / life insurance claim disputes complaint against Euroins AD

Decision detail

Summary

Mr S purchased a single trip travel insurance policy with Euroins AD for a November 2023 holiday. At the airport, the tour manager deemed Mr S unfit to travel due to apparent confusion, shakiness, and difficulty answering questions, and arranged for his family to collect him. Mr S claimed for cancellation but Euroins AD rejected the claim because he had not provided a medical certificate as required by the policy terms and his circumstances were not a specified covered event. The ombudsman upheld Euroins AD's decision, finding the policy terms were clear, the tour manager was not a medical professional, and Mr S had failed to meet the contractual requirement for a medical certificate.

The Ombudsman's reasoning

The ombudsman applied FCA industry rules requiring insurers to handle claims fairly and not unreasonably reject claims. The policy terms clearly specified that cancellation was only covered for listed events (death, illness, coronavirus diagnosis, jury service, redundancy, home damage, passport theft, or Armed Forces/emergency services duty), and Mr S' circumstances did not fall within these categories. Critically, the policy explicitly excluded claims where a medical certificate from a medical practitioner had not been obtained. The tour manager's opinion, while concerning, was not a medical professional's assessment and therefore could not substitute for the required medical certificate. The ombudsman concluded Euroins AD acted fairly in declining the claim based on the policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website