Not upheld: claim exclusions and point of sale disclosure complaint against Financial & Legal Insurance Company Ltd

Decision detail

Summary

Mr W complained that F&L treated him unfairly when handling his pet insurance claim, arguing that policy limits were not made clear at point of sale. F&L provided screenshots demonstrating that Mr W was presented with information about exclusions for diagnostic tests and medication costs not dispensed by the vet. The ombudsman found that Mr W was likely presented with this information despite his lack of recall, and that F&L was entitled to rely on policy exclusions when assessing the claim. The ombudsman did not uphold the complaint, finding that F&L properly limited the claim in accordance with policy terms.

The Ombudsman's reasoning

The ombudsman was persuaded that Mr W was presented with information about diagnostic test exclusions at point of sale, despite his lack of recall, given the time elapsed and F&L's assertion that the information was mandatory. The ombudsman found that not all exclusions need to be highlighted unless unusual or significant, and the prescription exclusion did not meet this threshold. The policy document made limitations clear enough for Mr W to satisfy himself about coverage adequacy. F&L was therefore entitled to rely on policy terms when assessing the claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website