Not upheld: Travel / life insurance claim disputes complaint against Allianz Insurance plc

Decision detail

Summary

Mr S complained that Allianz unfairly declined a pet insurance claim for his dog's skin condition treatment and added a skin disorder exclusion backdated to the policy start. The claim was declined because Mr S had not disclosed that his dog received veterinary treatment for eczema in June 2024, six months before taking out the policy in December 2024. The ombudsman found that the policy application questions clearly asked about any prior illness or veterinary visits, and Mr S should have disclosed the June 2024 treatment. Under CIDRA, this failure to take reasonable care constituted a careless qualifying misrepresentation, and Allianz was entitled to add the exclusion retrospectively, putting Mr S in the position he would have been in had he answered accurately. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the Consumer Insurance (Disclosures and Representations) Act 2012 (CIDRA) and found that Mr S failed to take reasonable care by not disclosing the June 2024 veterinary treatment, which was only six months prior to policy sale and involved prescribed medication. The ombudsman was satisfied this constituted a careless misrepresentation and a qualifying misrepresentation, as Allianz demonstrated it would have offered the policy on different terms (with a skin disorder exclusion). Under CIDRA, Allianz was entitled to treat the policy as if it had been issued with the exclusion from inception, making the claim fairly declined.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website