Not upheld: Home insurance claim disputes complaint against Forsakringsaktiebolaget Agria (publ)

Decision detail

Summary

Mr L complained that Agria would not pay his claim for hydrotherapy sessions until the treatment was completed, despite him paying in advance for a course of 10 sessions. He argued the policy terms do not require treatment to be completed before payment and was also unhappy with delays in claims handling. The ombudsman found that the policy covers treatment the pet receives, which logically means treatment must have been carried out for it to be covered, and it is reasonable for an insurer to require this confirmation before settling claims. The ombudsman upheld Agria's decision not to pay for uncompleted treatment and found the £150 compensation for service delays to be fair, therefore not upholding the complaint.

The Ombudsman's reasoning

The ombudsman applied the policy terms as the starting point for determining fairness. The policy covers treatment the pet receives, which logically means treatment must have been carried out for it to be covered. The ombudsman found it reasonable for an insurer to require confirmation that treatment has taken place before settling a claim, as pet insurance covers treatment costs and there is no guarantee all prepaid treatment will be completed. The ombudsman also noted that Mr L was entitled to claim for the two sessions that had taken place, but no payment was due as the cost was below the excess.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website