Upheld: unfair policy exclusion and claim handling complaint against Pinnacle Insurance Limited
Financial Ombudsman decision DRN-6179075 of 2026-04-02T00:00:00+00:00. unfair policy exclusion and claim handling complaint against Pinnacle Insurance Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6179075 |
|---|---|
| Decision date | 2026-04-02T00:00:00+00:00 |
| Firm | Pinnacle Insurance Limited |
| Product | pet insurance |
| Claim type | unfair policy exclusion and claim handling |
| Outcome | Upheld |
| Remedy | Pinnacle Insurance Limited must: (1) remove the exclusion for spine and disc problems from the policy from the date it was added; (2) reconsider Mr M's claim against the remaining policy terms; (3) pay any further sums due to Mr M, or if Mr M has already paid, reimburse those amounts with interest at 8% simple from the date of payment until settlement; (4) pay Mr M £250 for avoidable distress and inconvenience caused by the claim decline and handling issues; (5) provide tax deduction information if required by HMRC. |
Summary
Mr M complained that Pinnacle Insurance Limited wrongly applied an exclusion for spine and disc problems to his pet insurance policy for his dog C. Although a vet initially suspected spinal pain when C presented with discomfort in January 2025, subsequent investigation identified an anal gland infection as the cause, which resolved with treatment. When Mr M claimed in May 2025 for investigation costs related to a disc extrusion diagnosis, Pinnacle refused to cover further treatment based on the exclusion. The ombudsman found that Pinnacle lacked clear evidence that C had actually suffered from back pain prior to the policy being taken out and therefore the exclusion should not have been applied. The ombudsman upheld the complaint and ordered Pinnacle to remove the exclusion, reconsider the claim, reimburse any amounts paid with interest, and pay £250 compensation for distress and inconvenience.
The Ombudsman's reasoning
The ombudsman found that while spinal pain was suspected when C first presented in January 2025, the underlying cause was subsequently identified as an anal gland infection, which resolved with treatment. On subsequent visits, no spinal pain was found. The ombudsman preferred the opinion of C's own veterinarian, who examined C at the relevant times and provided specific, consistent evidence, over Pinnacle's appointed vet who had not seen C at the time of symptoms and whose opinion was deemed speculative. The ombudsman concluded that Pinnacle lacked clear evidence that C had actually suffered from back pain prior to the policy being taken out, and therefore the exclusion should not have been applied.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Pinnacle Insurance Limited, all decisions | 32 | 14% |
Source
Read the original decision on the Financial Ombudsman Service website