Not upheld: claim declined - waiting period exclusion complaint against Casualty & General Insurance Company (Europe) Ltd

Decision detail

Summary

Mr C complained that C&G unfairly declined his pet insurance claim for treatment costs related to a laryngeal mass that resulted in his pet's euthanasia. The policy contained a 10-day waiting period exclusion. Clinical notes showed the mass was first identified on 4 August, before the policy started on 17 August 2025, and subsequently grew on 18 and 22 August. The ombudsman found the claim fell within the waiting period exclusion and was correctly declined, rejecting Mr C's argument that there were two different masses. The ombudsman also found C&G's handling of the claim and communications were appropriate and sensitive to Mr C's loss.

The Ombudsman's reasoning

The ombudsman found that the laryngeal mass that led to the claim was first identified on 4 August, which was within the 10-day waiting period of the policy that started on 17 August 2025. Even if the initial mass on 4 August was caused by minor trauma, the mass that presented on 18 August and subsequently grew was the same mass that led to the treatment costs claimed, and this fell within the waiting period exclusion. The ombudsman rejected Mr C's argument that there were two different masses. Additionally, the firm's handling of the claim and communications were appropriate and sensitive to Mr C's circumstances.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website