Upheld: unfair claim decline - pre-existing condition exclusion complaint against Red Sands Insurance Company (Europe) Limited
Financial Ombudsman decision DRN-6065704 of 2026-05-15T00:00:00+00:00. unfair claim decline - pre-existing condition exclusion complaint against Red Sands Insurance Company (Europe) Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6065704 |
|---|---|
| Decision date | 2026-05-15T00:00:00+00:00 |
| Firm | Red Sands Insurance Company (Europe) Limited |
| Product | Other regulated product |
| Claim type | unfair claim decline - pre-existing condition exclusion |
| Outcome | Upheld |
| Remedy | Red Sands must pay: (1) Mr W's claim subject to remaining policy terms and conditions; (2) interest at 8% simple per annum from the date the claim was first declined until settlement; (3) £100 compensation for distress and inconvenience. Payment must be made within 28 days of Mr W's acceptance of the decision, with additional 8% interest if payment is late. |
Summary
Mr W claimed on his pet insurance policy for treatment of his dog's intervertebral disc extrusion (IVDE) requiring spinal surgery. Red Sands declined the claim citing a pre-existing condition exclusion, relying on medical records showing the dog had previously undergone spinal surgery. The ombudsman upheld the complaint, finding that Red Sands failed to establish the two surgeries were caused by the same condition or directly connected, and that Mr W could not reasonably have been aware of the prior surgery given the dog was adopted from overseas with unavailable pre-2024 medical records. Red Sands was directed to pay the claim, 8% interest, and £100 compensation.
The Ombudsman's reasoning
The ombudsman applied the standard two-part test for pre-existing condition exclusions: (1) whether the claimed condition is the same as or directly connected to a pre-existing condition, and (2) whether the policyholder was aware of the pre-existing condition at policy inception. On the first part, the ombudsman found that spinal surgery is a procedure, not a condition itself, and Red Sands failed to establish that the two surgeries were caused by the same underlying condition or were directly connected. On the second part, the ombudsman found it unsurprising that Mr W would not have been aware of the dog's full medical history given the unavailable pre-2024 records and the fact that the previous surgery only became apparent during the MRI scan in April 2025, significantly after policy inception in October 2024.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Red Sands Insurance Company (Europe) Limited, all decisions | 994 | 49% |
| Other regulated product, all decisions | 52,408 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website