Upheld: unfair claim rejection based on pre-existing condition exclusion complaint against Admiral Insurance (Gibraltar) Limited
Financial Ombudsman decision DRN-6131189 of 2026-05-21T00:00:00+00:00. unfair claim rejection based on pre-existing condition exclusion complaint against Admiral Insurance (Gibraltar) Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6131189 |
|---|---|
| Decision date | 2026-05-21T00:00:00+00:00 |
| Firm | Admiral Insurance (Gibraltar) Limited |
| Product | pet insurance |
| Claim type | unfair claim rejection based on pre-existing condition exclusion |
| Outcome | Upheld |
| Remedy | Admiral must: (1) pay Mr W's claim subject to remaining policy terms; (2) pay 8% simple interest on any amounts Mr W already paid to his vet from the date of payment until settlement; (3) pay £100 compensation for distress and inconvenience caused by delays in handling the claim (if not already paid). |
Summary
Mr W claimed on his pet insurance policy for his dog's prostate abscess treatment in April 2025. Admiral rejected the claim as a pre-existing condition, citing an enlarged prostate with cysts identified in March 2022, before the January 2024 policy start date. While Admiral's vet provided evidence linking the cysts to the subsequent abscess, Mr W's original vet had not indicated this was a concern requiring follow-up treatment. The ombudsman upheld the complaint, finding it unfair to apply the pre-existing condition exclusion where Mr W could not reasonably have anticipated the condition would lead to future treatment based on his vet's advice. Admiral was ordered to pay the claim plus interest and £100 compensation.
The Ombudsman's reasoning
While the policy wording technically supports the pre-existing condition exclusion and Admiral's vet provided evidence of a medical link between the March 2022 prostate issue and the April 2025 claim, the ombudsman applied the FOS long-standing approach that it is not fair to apply such exclusions where the policyholder could not reasonably have been aware of the condition's implications. Although Mr W was aware of the enlarged prostate and cysts, his vet gave no indication this would require further investigation or treatment, and no issues arose before the policy started. Therefore, it would not be reasonable for Mr W to have anticipated this would lead to future treatment.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Admiral Insurance (Gibraltar) Limited, all decisions | 1,935 | 44% |
Source
Read the original decision on the Financial Ombudsman Service website