Not upheld: Travel / life insurance claim disputes complaint against Red Sands Insurance Company (Europe) Limited

Decision detail

Summary

Miss H claimed on her Red Sands pet insurance policy for treatment of her pet's heart condition (Mitral Valve Disease) diagnosed in December 2024. Red Sands declined the claim, arguing the condition first presented more than 12 months prior (December 2023) when a heart murmur was detected and investigation recommended, placing it outside the 12-month coverage window. Red Sands also applied an exclusion for all heart conditions. The ombudsman upheld Red Sands' position, finding the December 2023 presentation with clinical signs and recommended investigation meant the 12-month period had expired by December 2024, and the heart condition exclusion was fair and related to the claimed condition.

The Ombudsman's reasoning

The ombudsman found that the pet's condition was the same one presenting in December 2023 when clinical signs were evident and investigation was recommended, meaning the 12-month coverage period had expired by December 2024. The ombudsman distinguished between the 2021 heart murmur (which was not investigated) and the December 2023 murmur (which was recommended for investigation), finding the latter was clearly a problem requiring treatment planning. The exclusion for all heart conditions was deemed fair and related to the claimed condition under the policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website