Not upheld: coverage dispute - ongoing condition and policy renewal requirement complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Mr G complained that Admiral Insurance would not cover his cat's ongoing medical condition unless he renewed his pet insurance policy. His treatment began in July 2025 and was due to continue past the October 2025 renewal date. Admiral required policy renewal and continued premium payments to maintain cover. The ombudsman found the policy terms clearly stated that cover for each condition is provided for 12 months only while the policy remains in force and premiums are paid, making Admiral's requirement to renew the policy reasonable and not unusual. The ombudsman also found it fair that no premium refund was offered after a claim had been made. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found the policy terms clearly state that cover for each condition is provided for 12 months only while the policy remains in force and premiums are paid. The treatment started in July 2025, so Mr G was entitled to 12 months of cover from that date, but only if the policy continued without break and premiums were maintained. The October 2025 renewal was necessary to continue cover through July 2026. The ombudsman found this requirement reasonable and not unusual in pet insurance, as it would be unreasonable to expect an insurer to pay claims for treatment when the policy is no longer in force and no premiums are being paid. The refusal to provide a refund after a claim was made was also found to be standard practice and fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website