Upheld: Travel / life insurance claim disputes complaint against Wakam
Financial Ombudsman decision DRN-6211079 of 2026-06-19T00:00:00+00:00. Travel / life insurance claim disputes complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6211079 |
|---|---|
| Decision date | 2026-06-19T00:00:00+00:00 |
| Firm | Wakam |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Wakam must pay the claim for cherry eye surgery in line with remaining policy terms and any applicable excess. Wakam must pay 8% simple interest on amounts paid to Mrs C from the date she paid the vet until settlement. The £100 already paid is retained as compensation for distress and inconvenience. Wakam must provide a tax deduction certificate if requested. |
Summary
Mrs C claimed on her pet insurance policy with Wakam for surgery to treat her dog's prolapsed third eyelid (cherry eye) diagnosed on 27 June 2025. Wakam rejected the claim under a 14-day waiting period exclusion, relying on vet notes from 16 June showing eye irritation and discharge. The ombudsman upheld Mrs C's complaint, finding that Wakam failed to establish a causal link between the 16 June symptoms and the cherry eye. Veterinary evidence indicated that eye discharge is not a typical preceding sign of gland prolapse, and Wakam provided no expert evidence to counter this. Wakam was ordered to pay the claim plus 8% simple interest from the date Mrs C paid the vet, with the previously paid £100 retained as compensation.
The Ombudsman's reasoning
The ombudsman applied the policy exclusion for illnesses with symptoms in the waiting period but found that Wakam failed to establish a causal link between the 16 June symptoms and the cherry eye diagnosed on 27 June. The veterinary evidence clearly indicated that eye discharge is not a typical sign of prolapsed eyelid and is not a recognised risk factor for its development. There was no further reference to eye discharge in the notes between 16 June and 27 June, and Mrs C reported the prolapsed eyelid started on 27 June. Since Wakam sought to apply a policy exclusion, the burden was on it to demonstrate the exclusion applied on the balance of evidence. Having provided no veterinary evidence to counter the treating vet's opinion, Wakam failed to meet this burden.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam, all decisions | 269 | 51% |
| Travel / life insurance claim disputes, all decisions | 20,052 | 31% |
| Other regulated product, all decisions | 47,449 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website