Not upheld: Home insurance claim disputes complaint against Europ Assistance SA

Decision detail

Summary

Mr and Mrs D complained about Europ Assistance SA's settlement offer of £1,000 for Mrs D's dislocated shoulder sustained during a diving holiday. They sought reimbursement for all missed dives from the date of the accident, arguing the purpose of their trip was frustrated. Europ Assistance SA assessed the claim under the medical assistance and expenses section (offering £500 each) rather than the 'cutting short your trip' section, as they did not return home early. The ombudsman did not uphold the complaint, finding that the policy terms were correctly applied and the settlement was fair, as Mrs D was not confined to her cabin, retained access to all-inclusive amenities, and the medical evidence did not advise cutting the trip short.

The Ombudsman's reasoning

The ombudsman applied the policy terms strictly and found that the 'cutting short your trip' section did not apply because Mr and Mrs D did not return home early. The ombudsman considered whether to depart from a strict application of the terms but concluded it would not be fair and reasonable to do so because: (1) Mrs D was not confined to her cabin or prevented from all activities; (2) medical evidence did not advise cutting the trip short; (3) the all-inclusive package meant other benefits remained available; (4) Mr D was uninjured and could have continued diving; and (5) the policy does not cover loss of enjoyment. The ombudsman found the £1,000 offer appropriate given the total package costs and that Mrs D missed approximately half her dives.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website