Upheld: unfair claim decline based on pre-existing condition exclusion complaint against Wakam
Financial Ombudsman decision DRN-6259602 of 2026-05-06T00:00:00+00:00. unfair claim decline based on pre-existing condition exclusion complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6259602 |
|---|---|
| Decision date | 2026-05-06T00:00:00+00:00 |
| Firm | Wakam |
| Product | pet insurance |
| Claim type | unfair claim decline based on pre-existing condition exclusion |
| Outcome | Upheld |
| Remedy | Wakam must: (1) pay Mrs G's claim in accordance with remaining policy terms; (2) pay interest at 8% per year simple from the date the claim was made until settlement; (3) pay £100 compensation for distress, inconvenience, and confusion caused by the claim decline and the inconsistent acceptance of another claim for the same condition. |
Summary
Mrs G complained that Wakam unfairly declined her pet insurance claim for anxiety treatment. Wakam relied on clinical notes referencing occasional anxious moments in January 2024 and anxiety at 6 months of age in April 2005 to argue the condition was pre-existing. The ombudsman found these references were isolated and minor—relating to vet visits and normal hormonal development—and did not constitute evidence of the generalized anxiety disorder later diagnosed. The ombudsman concluded Mrs G could not reasonably have known these fleeting incidents would require future treatment and upheld the complaint, ordering Wakam to pay the claim plus interest and £100 compensation.
The Ombudsman's reasoning
The ombudsman found that Wakam's reliance on isolated, minor references to anxiety in clinical notes was insufficient to establish that the pet was exhibiting the generalized anxiety disorder later claimed for. The January 2024 note referenced only occasional anxious moments in the context of a vet visit, and the April 2005 reference to anxiety at 6 months of age was explained by the vet as normal hormonal development. Crucially, there was no evidence that Mrs G would have reasonably known these fleeting, minor incidents were precursors to a condition requiring future treatment. The ombudsman was also troubled by Wakam accepting another claim for the same condition while declining this one.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam, all decisions | 263 | 51% |
Source
Read the original decision on the Financial Ombudsman Service website