Not upheld: claim decline - scope of cover complaint against SiriusPoint International Insurance Corporation

Decision detail

Summary

Mr and Mrs M claimed on their travel insurance after Mr M suffered a serious accident abroad that required surgery and prevented him from driving their car home. SiriusPoint settled most of the claim including return flights but declined to cover the cost of returning the car to the UK. The ombudsman found that while the vehicle being stranded was a direct consequence of the insured medical event, the policy terms only cover returning the insured person home when they cannot use their booked transport, not the recovery of vehicles. The ombudsman concluded SiriusPoint acted reasonably in declining this part of the claim and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman considered the policy terms which cover extra transport costs for returning the insured person home when medically necessary and they cannot use their booked transport. SiriusPoint correctly paid for alternative flights as Mr M could not use his car. However, the policy does not extend to covering the recovery of a vehicle left behind. The ombudsman found the policy wording is not ambiguous and that vehicle recovery is simply not within the scope of cover. While sympathetic to Mr M's situation, the ombudsman concluded that not all consequences flowing from an insured event are covered, and it is standard practice for policies to list what is covered rather than what is excluded.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website