Partially upheld: Home insurance claim disputes complaint against Antares Insurance Company Limited

Decision detail

Summary

Mr G claimed on his Antares pet insurance policy for his pet's diagnosed condition, but Antares declined the claim based on a 10-day waiting period exclusion for illnesses beginning within the first 10 days of cover. The ombudsman upheld the decline, finding veterinary clinical notes showed the pet exhibited lameness for 1.5 weeks prior to the vet appointment on 23 September, placing onset within the exclusion period that began 7 September. However, the ombudsman found Antares took an unreasonable four months to assess the claim and awarded £100 compensation for the resulting trouble, upset, and inconvenience to Mr G.

The Ombudsman's reasoning

The ombudsman found that the veterinary clinical notes provided independent evidence that the pet was experiencing lameness for approximately 1.5 weeks prior to the 23 September appointment, placing the onset of illness within the first 10 days of the policy (by 16 September). The clinical notes were found more reliable than Mr G's later statement that he only noticed lameness the evening before the vet visit. The ombudsman concluded the eventual diagnosis was likely related to the symptoms presented during the exclusion period. However, the ombudsman found Antares took unreasonably long (four months) to reach their decision and awarded compensation for the resulting stress and inconvenience, despite the claim decline being justified.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website