Upheld: unfair claim decline complaint against Fortegra Europe Insurance Company Ltd
Financial Ombudsman decision DRN-6008091 of 2026-04-27T00:00:00+00:00. unfair claim decline complaint against Fortegra Europe Insurance Company Ltd. Outcome: Upheld.
Decision detail
| Reference | DRN-6008091 |
|---|---|
| Decision date | 2026-04-27T00:00:00+00:00 |
| Firm | Fortegra Europe Insurance Company Ltd |
| Product | Other regulated product |
| Claim type | unfair claim decline |
| Outcome | Upheld |
| Remedy | Fortegra Europe Insurance Company Ltd must: (1) Accept Mrs A's claim subject to remaining policy terms; (2) Pay Mrs A £75 compensation for loss of enjoyment of the sofa resulting from the unfair claim decline. |
Summary
Mrs A purchased a sofa in December 2023 and took out furniture insurance with Fortegra covering accidental staining. In May 2025, she discovered staining on one headrest and made a claim. Fortegra declined the claim based on a technician's report suggesting the staining was caused by body oils and grease built up over time, which fell within policy exclusions. Mrs A disputed this, stating the staining appeared suddenly. The ombudsman upheld the complaint, finding Fortegra had not sufficiently proven the exclusion applied. The physical evidence, including colour transfer, high acidity, and the stain's distinct appearance on only one of three headrests, was inconsistent with gradual accumulation. Fortegra was directed to accept the claim and pay £75 compensation.
The Ombudsman's reasoning
The ombudsman placed the burden on Fortegra to show an exclusion most likely applied. The technician's report used language suggesting possibility rather than certainty. The ombudsman found the physical evidence inconsistent with gradual staining: the distinct stain appearance, colour transfer (more consistent with recent stains), high acidity (inconsistent with body oils), and the fact that Mrs A would likely have noticed gradual staining over 15 months. The staining appearing on only one of three headrests despite multiple users also contradicted the gradual accumulation theory. The ombudsman concluded the staining could have resulted from an external source not excluded under the policy.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Fortegra Europe Insurance Company Ltd, all decisions | 139 | 53% |
| Other regulated product, all decisions | 52,408 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website