Not upheld: claims handling, poor communication, failure to notify complaint against INTACT INSURANCE UK LIMITED

Decision detail

Summary

Mr D complained that Intact unfairly declined approximately £5,000 of pet insurance claims for his dog's treatment after the policy's £10,000 annual vet fees limit was reached, and that Intact failed to warn him he was approaching the limit. Intact had experienced a system error that prevented timely notification of the declined claims, and Mr D only discovered this when his vet contacted Intact directly. While the ombudsman found that Intact breached communication guidelines and caused Mr D distress, particularly during a difficult period in his life, the policy terms clearly stated the annual limit and Mr D had received notifications of agreed claims that would have enabled him to track spending. The ombudsman determined that the £300 compensation Intact had already paid was fair and reasonable, and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman found that while Intact's policy terms clearly stated the £10,000 annual limit for vet fees and this was made transparent in the documentation, Intact failed to provide timely communication when claims were declined due to a system error. However, the ombudsman concluded that Mr D had received notifications of agreed claims which would have allowed him to track spending against the limit. The ombudsman determined that the policy limit was fair and reasonable, and that Intact's failure to communicate, while a breach of guidelines causing distress and inconvenience, did not justify requiring Intact to pay claims beyond the policy limit when cover had been exhausted and limitations were clearly disclosed. The £300 compensation already paid was deemed adequate recognition of the communication failure.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website