Not upheld: claims handling - application of policy limit complaint against Pinnacle Insurance Limited

Decision detail

Summary

Mr D complained that Pinnacle Insurance Limited unfairly applied an inner claims limit of £750 to his pet insurance claim for cruciate ligament treatment, when he believed he was entitled to up to £6,000 of cover. The ombudsman examined the policy documents and found that the £750 limit was clearly stated in the policy schedule and terms, applying to cruciate ligament ruptures, tears, damage, and associated costs. Although the limit was not mentioned in the IPID, the ombudsman concluded that the policy schedule and terms provided sufficient clarity for Pinnacle to apply the limit as they did. The ombudsman distinguished this claims handling complaint from a potential separate complaint about the sale of the policy and did not uphold Mr D's complaint.

The Ombudsman's reasoning

The ombudsman found that the £750 inner limit for cruciate ligament treatment was clearly stated in the policy schedule and terms when read together. Although the limit was not mentioned in the IPID, the policy schedule provided sufficient clarity for Pinnacle to rely on it as underwriters. The ombudsman distinguished between the current complaint about claims handling and a potential separate complaint about the sale of the policy, noting that if Mr D felt misled at the point of sale, that would require a separate complaint against the policy seller.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website