Not upheld: Other regulated complaint complaint against Pinnacle Insurance Limited

Decision detail

Summary

Mr L complained that Pinnacle Insurance Limited unfairly applied a £500 policy limit to complementary treatment (physiotherapy) for his dog, arguing it should be classified as primary treatment rather than complementary, and that he should receive cover from the previous policy year since the treatment was pre-authorised before renewal. The ombudsman found that the policy terms clearly set out the £500 limit for complementary treatment, that this is a standard practice among pet insurers, and that the limit resets annually without rollover. The complaint was not upheld as the policy terms were clear, fair, and not misleading, and Pinnacle was entitled to make the commercial decision to limit complementary treatment cover.

The Ombudsman's reasoning

The ombudsman applied the principle that insurers are entitled to set commercial limits on cover and that it is not the ombudsman's role to dictate what level of cover should be provided. The policy documents clearly set out the £500 limit for complementary treatment, and this information was presented clearly to policyholders. The limit resets each policy year and does not roll over. The change of underwriter does not alter the fact that treatment provided after renewal falls under the new policy year's terms. The pre-authorisation was time-limited and Mr L could have reapplied when the delay occurred.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website