Not upheld: Home insurance claim disputes complaint against Antares Insurance Company Limited

Decision detail

Summary

Mrs G claimed for vets' fees for her dog's gastroenteritis treatment under her pet insurance policy with Antares. Antares declined the claim, arguing the gastroenteritis was an associated condition linked to the dog's lymphoma treatment, and the policy limit for lymphoma had already been reached. Mrs G disputed this, arguing there was no clear veterinary evidence linking the conditions and that medical uncertainty should be resolved in her favour. The ombudsman found it was fair for Antares to conclude the gastroenteritis was associated with the lymphoma, based on the known 60-80% incidence of gastrointestinal side effects from the chemotherapy protocol used, the timing of onset immediately after treatment, and precautionary medication given at subsequent treatment. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the balance of probabilities test to determine whether gastroenteritis was more likely than not to be an associated condition. Although four possible causes existed, the veterinary evidence showing gastrointestinal side effects occur in 60-80% of CHOP protocol cases, combined with the timing of onset immediately after treatment and the precautionary medication given at the next treatment, indicated it was more likely than not that the gastroenteritis was associated with the lymphoma treatment. This conclusion was reasonable under the policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website