Not upheld: claim decline and application of policy exclusions complaint against Intact Insurance UK Limited

Decision detail

Summary

Mr G and Mrs T complained that Intact Insurance unfairly declined to pay for certain items in a veterinary claim, including a probiotic digestive aid and dog food that had been clinically recommended by their vet. Intact had deducted these costs from a £382 claim, citing policy exclusions for over-the-counter supplements and food not prescribed for specific covered conditions. The ombudsman found the policy terms were clear and explicit in excluding these items, and that Intact correctly applied the exclusions. The ombudsman determined these were not 'main exclusions' requiring prominence in the product information document as they only limited cover in specific circumstances. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy terms clearly excluded over-the-counter supplements and probiotics, and limited food coverage to specific medical conditions (urinary crystals/stones, renal and thyroid conditions). Although the items were clinically recommended by the vet, the policy exclusions were explicit and applied to these circumstances. The ombudsman determined that these exclusions did not constitute 'main exclusions' requiring prominence in the IPID as they only limited cover in specific and limited circumstances. As an insurer, Intact was entitled to decide the extent of risk it wanted to cover and price accordingly.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website