Not upheld: claim declined - pre-existing condition exclusion complaint against Wakam

Decision detail

Summary

Ms G complained that Wakam unfairly declined her claim for dental extractions on her pet insurance policy. Ms G argued that the specific teeth removed in October 2025 had not been identified as having issues before her cover started in July 2025. However, clinical notes from March 2025 recorded that the pet had tartar and would benefit from dental treatment with possible canine extractions. The ombudsman found that these March 2025 notes were sufficient to establish pre-existing dental problems and that Ms G was aware treatment would likely be needed before cover commenced. The ombudsman concluded that Wakam fairly applied the pre-existing condition exclusion and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman concluded that the March 2025 clinical notes, which recorded tartar and recommended dental treatment, were sufficient to establish that the pet had pre-existing dental problems before cover commenced. Although the March 2025 notes did not specify which individual teeth were affected, the ombudsman found that dental disease is progressive in nature and that Ms G was made aware a problem existed that would likely require treatment. The ombudsman accepted that some teeth extracted in October 2025 may have been removed due to proximity to more problematic areas affected by dental disease. Given the overwhelming reason for removal was periodontal disease noted seven months earlier as being in less advanced stages, the ombudsman concluded it was more likely than not that the condition was pre-existing and Ms G was aware of the likelihood of treatment being needed before cover was in place.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website