Not upheld: claim declined - application of policy exclusion complaint against Antares Insurance Company Limited

Decision detail

Summary

Ms M claimed on her pet insurance policy for veterinary treatment costs after her dog became ill and was subsequently euthanised. Antares declined the claim citing a policy exclusion that prevents cover for conditions beginning within the first 10 days of the policy start date. Ms M argued she should be covered because the diagnosis and death occurred after the waiting period. The ombudsman found the claim was fairly declined because clinical notes showed the dog was unwell on 22 January, only three days after the 19 January policy start, meaning the condition originated within the excluded period. The ombudsman noted that such exclusions are standard in pet insurance and that Antares had already paid appropriate compensation for delays in handling the claim.

The Ombudsman's reasoning

The ombudsman found that the policy terms clearly exclude cover for conditions present within the first 10 days of the policy start date. This is a standard exclusion in pet insurance. The clinical notes established that the dog showed signs of illness on 22 January, which was within the 10-day exclusion period, even though the diagnosis and death occurred later. The exclusion applies to the condition's onset, not its diagnosis or outcome. The compensation and premium refund already paid by Antares adequately addressed the delays in claim handling.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website