Upheld: unfair claim decline based on pre-existing condition exclusion complaint against Wakam
Financial Ombudsman decision DRN-6217414 of 2026-05-27T00:00:00+00:00. unfair claim decline based on pre-existing condition exclusion complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6217414 |
|---|---|
| Decision date | 2026-05-27T00:00:00+00:00 |
| Firm | Wakam |
| Product | pet insurance |
| Claim type | unfair claim decline based on pre-existing condition exclusion |
| Outcome | Upheld |
| Remedy | Pay Mrs M's claim with interest at 8% per year simple from the time the claim was initially declined until reimbursement. Pay Mrs M £100 compensation for distress and inconvenience caused by the claim decline during a difficult time of grieving. |
Summary
Mrs M claimed on her Wakam pet insurance policy for treatment of her pet's condition in 2025, but Wakam declined the claim as a pre-existing condition, arguing it was a recurrence of haemangiosarcoma diagnosed in December 2023 that resulted in leg amputation. The ombudsman upheld Mrs M's complaint, finding that the 2023 histopathology report indicated the cancer carried a low risk of recurrence and there was no evidence of recurrence between December 2023 and November 2024 when the policy started, so Mrs M had no reason to know treatment would be needed. Furthermore, the 2025 investigations did not definitively prove recurrence or metastasis - only suspicious findings - so Wakam failed to establish the pre-existing condition exclusion applied. Wakam was directed to pay the claim with 8% interest and £100 compensation.
The Ombudsman's reasoning
The ombudsman applied a two-part test: first, whether Mrs M knew or ought to have known at point of sale that the pet would need treatment for this condition again; and second, whether Wakam proved the 2025 condition was actually a pre-existing condition within the policy terms. On the first point, the ombudsman found the 2023 histopathology report indicated cutaneous haemangiosarcoma carries a low risk of metastasis and longer survival times, and there was no evidence of recurrence between December 2023 and November 2024, so Mrs M had no reason to know treatment would be needed. On the second point, the ombudsman found the 2025 investigations did not reach a definitive diagnosis of recurrence or metastasis - the cytology was only suspicious and the vet cautioned against firm conclusions - so Wakam failed to prove the exclusion applied.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam, all decisions | 261 | 51% |
Source
Read the original decision on the Financial Ombudsman Service website