Upheld: Travel / life insurance claim disputes complaint against Wakam UK Limited
Financial Ombudsman decision DRN-5988802 of 2025-12-23T00:00:00+00:00. Travel / life insurance claim disputes complaint against Wakam UK Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-5988802 |
|---|---|
| Decision date | 2025-12-23T00:00:00+00:00 |
| Firm | Wakam UK Limited |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Wakam must reconsider the claim in line with remaining policy terms and conditions, cannot decline it as pre-existing, and must accept it meets the complementary treatment criteria. If accepted, Wakam must reimburse Mr T for treatment costs paid plus 8% simple interest per year from payment date. Wakam must pay total compensation of £250 (£150 already offered for incorrect cancellation plus £100 for unfair claim decline), less any amounts already paid, within 28 days. |
Summary
Mr T claimed on his pet insurance policy for physiotherapy costs for his dog P following lipoma removal surgery in April 2024. Wakam declined the claim, arguing it was for a pre-existing condition (elbow dysplasia from 2017) and that the complementary treatment criterion was not met because Mr T asked about physiotherapy first. The ombudsman found Wakam misapplied the pre-existing condition clause by not properly applying the 24-month lookback period from policy inception, and that lipomas were first documented in January 2023, after the policy started. The lameness was a new condition caused by recent surgery. The treating vet confirmed physiotherapy would be beneficial, satisfying the policy requirement. The ombudsman upheld the complaint and directed Wakam to reconsider the claim and pay £250 total compensation.
The Ombudsman's reasoning
The ombudsman found that Wakam misapplied the pre-existing condition clause by not properly applying the 24-month lookback period from the policy start date. Since lipomas were first documented in January 2023 (after the June 2020 policy start), they cannot be classified as pre-existing. The lameness following lipoma surgery was a new condition caused by the recent surgery, not the historical elbow dysplasia. Regarding complementary treatment, the vet's confirmation that physiotherapy would be 'highly beneficial' satisfied the policy requirement of being 'diagnosed as needing' the treatment, regardless of who raised the suggestion first. Joint supplements were considered preventative measures rather than treatment or medication.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam UK Limited, all decisions | 16 | 69% |
| Travel / life insurance claim disputes, all decisions | 19,183 | 32% |
| Other regulated product, all decisions | 51,105 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website