Not upheld: claim decline - breach of policy condition complaint against SiriusPoint International Insurance Corporation

Decision detail

Summary

Mr D claimed under his travel insurance policy after suffering a motorcycle accident while abroad and being admitted to hospital. SiriusPoint declined the claim because Mr D had not passed the required UK CBT test and did not hold a valid UK provisional licence, both conditions of the policy for motorcycle/moped cover. Mrs D, representing Mr D, complained that the licence requirement was a technical breach unrelated to the loss and that SiriusPoint had mis-advised her about coverage. The ombudsman found that SiriusPoint was entitled to rely on the clear policy terms, that the licence breach was directly related to the incident, and that there was no evidence of prejudice to Mr D from any communication failures. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that SiriusPoint was entitled to decline the claim because Mr D did not meet the policy conditions for motorcycle/moped cover, specifically lacking UK CBT certification and a valid UK provisional licence. The ombudsman rejected the argument that the licence issue was merely a technical breach unrelated to the loss, finding instead that it was directly connected to the incident. While acknowledging that SiriusPoint could have communicated more clearly about the licence requirement, the ombudsman found no evidence that Mrs D would have acted differently had she known, and therefore no prejudice to Mr D. The ombudsman also found no breach of duty regarding the delays in processing or the flight refund issue.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website