Partially upheld: claim decline decision and claim handling service failures complaint against Zurich Insurance Company Limited
Financial Ombudsman decision DRN-6247079 of 2026-04-08T00:00:00+00:00. claim decline decision and claim handling service failures complaint against Zurich Insurance Company Limited. Outcome: Partially upheld.
Decision detail
| Reference | DRN-6247079 |
|---|---|
| Decision date | 2026-04-08T00:00:00+00:00 |
| Firm | Zurich Insurance Company Limited |
| Product | travel insurance |
| Claim type | claim decline decision and claim handling service failures |
| Outcome | Partially upheld |
| Remedy | Zurich must pay Mr K £500 compensation for distress and inconvenience (if not already paid) and must deduct the cost of the CT scan dated around 24 November 2025 from the amount Mr K owes Zurich for medical costs. Mr K is free to provide Zurich with information about the local driving licence and request further review. |
Summary
Mr K complained about Zurich's handling of a travel insurance claim following an injury sustained while riding a motorbike abroad. Zurich declined the claim based on a policy exclusion for driving without the equivalent and appropriate valid UK driving licence for the vehicle category. The ombudsman found the claim decline decision was fair and reasonable, as Mr K could not produce evidence of holding a valid licence to drive the motorbike. However, the ombudsman partially upheld the complaint, finding that Zurich should have identified the driving licence issue earlier in the claims process, causing Mr K unnecessary confusion and distress. The ombudsman directed Zurich to pay £500 compensation for service failures and to deduct the cost of a CT scan from medical expenses owed.
The Ombudsman's reasoning
The ombudsman found that Zurich fairly and reasonably declined the claim based on the general exclusion in the policy regarding driving without the equivalent and appropriate valid UK licence for the category of vehicle. Mr K could not produce evidence of holding a valid licence to drive the motorbike he was riding. However, the ombudsman upheld service failures: Zurich should have identified the driving licence issue earlier, causing unnecessary confusion and distress. The ombudsman rejected Mr K's argument that he would have been discharged earlier if the claim had been declined sooner, finding no compelling medical evidence to support this. The ombudsman found it fair for Zurich to cover the cost of the CT scan it requested, as this was incurred after the decline decision was effectively taken.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Zurich Insurance Company Limited, all decisions | 4 | 25% |
Source
Read the original decision on the Financial Ombudsman Service website