Upheld: Home insurance claim disputes complaint against Antares Insurance Company Limited
Financial Ombudsman decision DRN-5703581 of 2025-08-12T00:00:00+00:00. Home insurance claim disputes complaint against Antares Insurance Company Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-5703581 |
|---|---|
| Decision date | 2025-08-12T00:00:00+00:00 |
| Firm | Antares Insurance Company Limited |
| Product | Other regulated product |
| Claim type | Home insurance claim disputes |
| Outcome | Upheld |
| Remedy | Antares Insurance Company Limited must settle the second claim in line with the remaining policy terms and pay interest at 8% per annum simple from the date Mr P paid the treatment costs to the date of settlement. If income tax deduction is required by HMRC, Antares must inform Mr P and provide a tax deduction certificate if requested. |
Summary
Mr P claimed on his horse insurance policy for treatment costs following a severe wound in September 2023, which was paid up to the £3,000 policy limit. In August 2024, he made a second claim for treatment that began in May 2024. Antares declined the second claim, treating it as a continuation of the first incident under the policy's definition that related diagnoses arising from an initial symptom presentation constitute one claimable incident. The ombudsman upheld the complaint, finding that the treating vet's evidence clearly demonstrated the symptoms in May 2024 were new and had not been seen before, making it a separate claimable incident. The ombudsman found the treating vet's detailed clinical analysis more persuasive than Antares' instructed vet's brief opinion and directed Antares to settle the claim with interest.
The Ombudsman's reasoning
The ombudsman found the treating vet's evidence more persuasive than Antares' instructed vet's opinion. The treating vet was involved throughout the treatment, provided detailed clinical analysis, and was explicit that the symptoms in late May 2024 were new and had not been seen before. While Antares' vet suggested the problem resulted from pain associated with the left hock from the original wound, this was not supported by detailed analysis of the clinical notes. The clinical evidence showed the horse had made good progress by early May 2024, and the new symptoms (narcoleptic fits and sleep deprivation) appeared to be a distinct presentation.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Antares Insurance Company Limited, all decisions | 7 | 21% |
| Home insurance claim disputes, all decisions | 25,340 | 38% |
| Other regulated product, all decisions | 51,105 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website