Not upheld: claim denial / policy interpretation complaint against HELVETIA GLOBAL SOLUTIONS LTD

Decision detail

Summary

Mr K complained that HGSL unfairly declined his fourth claim on a Tyre and Alloy Insurance policy, arguing the policy contained contradictory wording that entitled him to nine claims in three years but limited him to three per year. HGSL declined the fourth claim based on the three claims per 12-month period limit. The ombudsman found no contradiction, as the policy clearly allowed three claims per year up to a maximum of nine over 36 months. The exclusion was clearly stated in the policy wording and Insurance Product Information Document, and Mr K accepted these terms by not cancelling during the cooling-off period. The ombudsman also found no breach of Consumer Duty principles and upheld HGSL's decision to decline the claim.

The Ombudsman's reasoning

The ombudsman found no contradiction in the policy terms. The policy clearly allows three claims per year for each of the three years, totalling nine claims maximum over 36 months. This is a standard insurance practice to set both benefits and exclusions. The exclusion was clearly stated multiple times in the policy documentation and the Insurance Product Information Document. Mr K agreed to these terms by not cancelling during the cooling-off period. The policy wording is clear, fair, and not misleading, and complies with Consumer Duty principles.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website