Not upheld: Travel / life insurance claim disputes complaint against Red Sands Insurance Company (Europe) Limited

Decision detail

Summary

Mr L complained that Red Sands unfairly applied a £500 limit to physiotherapy treatment for his dog and imposed a four-week time limit on pre-authorisation. He argued the physiotherapy was active treatment, not complementary, and should be covered at the full £6,000 limit. He also objected to paying a second excess when the pre-authorisation expired before treatment could be completed. Red Sands acknowledged providing incorrect information about deductions and paid £50 compensation plus a £330 refund. The ombudsman did not uphold the complaint, finding that the policy terms clearly set out the £500 complementary treatment limit, which is standard practice, and that the four-week pre-authorisation period was reasonable and clearly communicated.

The Ombudsman's reasoning

The ombudsman applied the principle that insurers are entitled to set the level of cover they wish to provide, and it is not the ombudsman's role to dictate what cover should be offered. The policy terms clearly set out the £500 limit for complementary treatment, which is standard practice among pet insurers. The classification of physiotherapy as complementary treatment, rather than primary treatment, is a commercial decision for the insurer. The four-week pre-authorisation period was clearly communicated and Mr L could have reapplied if treatment was delayed. The change of underwriter at renewal does not alter the fact that treatment costs are only covered in the policy year in which they are incurred. The ombudsman rejected Mr L's argument that the pre-authorisation should have been extended or tied to the original policy year.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website