Upheld: unfair policy changes, fundamental alteration of lifetime cover terms complaint against Covea Insurance plc

Decision detail

Summary

Miss M complained that Covea Insurance unfairly changed the terms of her lifetime pet insurance policy at 2023 renewal by adding an exclusion for umbilical hernia treatment without making such fundamental changes sufficiently clear. While the ombudsman found the renewal documents adequately highlighted the changes, the exclusion represented a fundamental alteration to the lifetime cover promise that contradicted the policy's core nature. Covea failed to make the possibility of such significant changes abundantly clear at initial purchase, and later provided no evidence to support its assertion that the exclusion merely clarified pre-existing conditions. The ombudsman upheld the complaint and directed Covea to reconsider the claim, remove the exclusion from future renewals, and pay £100 compensation.

The Ombudsman's reasoning

While the renewal documents clearly highlighted changes, the application of an exclusion for umbilical hernia treatment represents a fundamental change to the type of lifetime cover promised. An insurer is entitled to make changes to a lifetime policy at renewal, but not changes so fundamental that they limit the original cover unless the possibility was made abundantly clear at initial purchase. Covea provided no such information initially. Additionally, Covea's later assertion that the exclusion merely clarified pre-existing conditions was unsupported by clinical evidence and was not the basis on which the claim was originally declined.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website