Not upheld: misrepresentation and claim handling complaint against Allianz Insurance Plc trading as Pet Plan

Decision detail

Summary

Mr B complained about how Allianz handled claims for his pet's feline lower urinary tract disorder. Allianz declined the claims citing both pre-existing condition exclusion and misrepresentation of the pet's clinical history. The ombudsman found that Mr B had failed to take reasonable care not to misrepresent when he answered 'No' to questions about his pet's health history, despite the pet showing symptoms of illness at least a week before cover commenced and having a vet appointment scheduled 11 minutes before the policy was taken out. Under CIDRA, this constituted a qualifying careless misrepresentation, entitling Allianz to decline the claims and apply the exclusion they would have imposed from the outset. Although Allianz acknowledged shortcomings in claim handling, the £971.43 paid in error was deemed sufficient compensation, and the complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA) to determine that Mr B failed to take reasonable care not to make a misrepresentation. The evidence clearly showed the pet was experiencing symptoms before cover commenced, Mr B was aware of this, and he did not declare it despite being asked clear, specific questions. The misrepresentation was qualifying because Allianz would have offered different terms (a urinary system exclusion) had the information been disclosed. As the misrepresentation was careless, Allianz was entitled to decline the claims and apply the exclusion. The £971.43 paid in error by Allianz exceeds reasonable compensation for the acknowledged claim handling shortcomings.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website