Upheld: Travel / life insurance claim disputes complaint against WDP Insurance Limited

Decision detail

Summary

Mr G purchased a phone and insured it with WDP on 5 September 2025. Intending to have the phone set up at a WDP affiliated shop, he lost it on 24 September 2025 and made a claim. WDP declined the claim alleging fraud because the phone had been activated on 15 September 2025, contrary to Mr G's initial statement that he had not turned it on. Mr G later explained that his son had activated the phone without his knowledge. The ombudsman upheld the complaint, finding that WDP failed to discharge its burden of proof of fraud, particularly given medical evidence of pre-existing family tensions, Mr G's vulnerability, and WDP's own agent's doubts about fraudulent intent. WDP was ordered to reconsider the claim under the policy's remaining terms and conditions.

The Ombudsman's reasoning

The burden of proof to establish fraud lies solely with WDP, and the standard is balance of probabilities in civil insurance matters. WDP failed to discharge this burden. The evidence shows Mr G genuinely did not know how to set up the phone, had legitimate reasons to use the shop's services, and had documented family problems with his son that explain why the son may have activated the phone without Mr G's knowledge. The change in Mr G's story is adequately explained by his subsequent interrogation of his son and is supported by medical evidence of pre-existing tension. WDP's own agent, who had multiple conversations with Mr G, expressed doubts about fraudulent intent and suggested payment. Mr G's vulnerable status and genuine shock on the recordings further support his credibility.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website