Upheld: Travel / life insurance claim disputes complaint against Wakam UK Limited
Financial Ombudsman decision DRN-6157349 of 2026-02-16T00:00:00+00:00. Travel / life insurance claim disputes complaint against Wakam UK Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6157349 |
|---|---|
| Decision date | 2026-02-16T00:00:00+00:00 |
| Firm | Wakam UK Limited |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Wakam directed to pay: (1) outstanding elements of Miss K's claim subject to remaining policy terms; (2) interest at 8% per year simple on outstanding claim elements from date Miss K paid them, or credit card interest incurred (whichever is greater), with Miss K to provide evidence for credit card interest claim; (3) £200 compensation for distress and inconvenience caused by unnecessary delays and claim decline. |
Summary
Miss K claimed on her Wakam pet insurance policy while abroad with her pet. Wakam agreed to cover claims for hip joint, back, and gastrointestinal issues but declined the costs of behavioural investigations, citing pre-existing condition exclusion. The ombudsman found this unfair because the pet's behavioural problems were explained by pain from the newly diagnosed illnesses that Wakam had agreed to cover, not standalone pre-existing behavioural conditions. The ombudsman upheld the complaint and directed Wakam to pay the full claim plus interest and £200 compensation for delays and distress.
The Ombudsman's reasoning
The ombudsman found that while the pet had pre-existing behavioural problems, the behavioural investigations conducted during the claim were related to investigating the newly diagnosed illnesses (hip joint, back, and gastrointestinal problems) that Wakam had agreed to cover. The pet's behavioural deterioration was explained by pain and discomfort from these illnesses rather than standalone pre-existing behavioural conditions. Since Wakam was covering the underlying illnesses, it was unfair to exclude the costs of investigations that led to diagnosing those illnesses. No veterinary evidence from Wakam demonstrated the behavioural investigations related to anything other than the covered illnesses.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam UK Limited, all decisions | 16 | 69% |
| Travel / life insurance claim disputes, all decisions | 19,183 | 32% |
| Other regulated product, all decisions | 51,105 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website