Not upheld: misrepresentation on health disclosure; claim decline; policy cancellation complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Miss J and Mr L complained that IPA unfairly declined their travel insurance claim and cancelled their policy after they cancelled a holiday due to illness. IPA had declined the claim on the basis that Miss J answered health questions incorrectly by not disclosing a medical procedure undertaken within the past 2 years. The ombudsman found that Miss J failed to take reasonable care in answering the clear medical questions and that this constituted a qualifying misrepresentation under CIDRA, as IPA demonstrated the specific policy would not have been offered with accurate information. IPA's actions of declining the claim, cancelling the policy, and offering a premium refund were in accordance with CIDRA remedies for careless misrepresentation. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that Miss J failed to take reasonable care by answering 'no' to a clear question about medical procedures in the past 2 years, despite having had a procedure. This constituted a qualifying misrepresentation under CIDRA because IPA demonstrated it would not have offered the specific policy purchased had the question been answered correctly. IPA's actions of declining the claim, cancelling the policy, and offering a premium refund were in accordance with CIDRA remedies for careless misrepresentation and were therefore fair and reasonable.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website