Not upheld: unfair application of policy terms / insufficient disclosure of co-payment complaint against Wakam

Decision detail

Summary

Mr S complained that Wakam unfairly applied a 20% co-payment to his pet insurance claim without providing sufficient warning. Wakam had included the co-payment term in the initial policy declaration and in annual renewal documentation since inception, with particular prominence in the 2024-2025 handbook covering the year of the claim. The ombudsman found that co-payment terms for older animals are common in pet insurance and that Wakam had clearly disclosed the term from inception and on each renewal in a clear, fair and not misleading manner. The ombudsman noted that policyholders have a responsibility to check their documents at renewal and that a 14-day cooling off period was available. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that co-payment terms for older animals are common in pet insurance and not unreasonable in themselves. However, insurers must make such terms clear, fair and not misleading. Wakam had disclosed the 20% co-payment from policy inception through the initial declaration, consistently in annual renewal documentation, and with particular prominence in the 2024-2025 handbook. The ombudsman noted that policyholders have a responsibility to check policy details at renewal, as highlighted in Wakam's documentation. The renewal notification was accompanied by full policy documents and online access to all materials. Additionally, a 14-day cooling off period allowed cancellation without charge if Mr S was unhappy after renewal. On balance, the ombudsman was satisfied that had Mr S checked his documents carefully as requested, he would have been aware of the co-payment.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website