Not upheld: Travel / life insurance claim disputes complaint against HDI Global Specialty SE

Decision detail

Summary

Mr L claimed on his pet insurance policy for treatment costs for his dog's laryngeal paralysis. HDI declined the claim citing the pre-existing condition exclusion. Mr L argued there was no diagnosis before the policy started and that the insurer was improperly equating symptoms with a condition. The ombudsman reviewed clinical records showing that in September 2024, just months before the January 2025 policy start, the vet had suspected laryngeal paralysis and recommended specific investigations for it. Although the condition was not formally diagnosed until after the policy commenced, the vet later confirmed the symptoms were linked to this condition. The ombudsman upheld HDI's decision, finding it fair to treat this as pre-existing since signs were present and investigated before the policy started, and Mr L was aware of the issue.

The Ombudsman's reasoning

The ombudsman applied the established FOS approach that pre-existing conditions can be fairly excluded if present before the policy, or directly related to or having the same underlying cause. The clinical notes clearly showed the vet suspected laryngeal paralysis and recommended specific investigations for it in September 2024, just months before the January 2025 policy start. Although no formal diagnosis had been made, the policy definition does not require a diagnosis - only that the pet showed signs of illness. The vet later confirmed the symptoms were linked to the condition. Therefore, it was fair for HDI to treat this as pre-existing, as Mr L was aware of the issue and the specific condition being investigated.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website