Not upheld: claim rejection - application of policy exclusion complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Mr and Mrs C claimed on their travel insurance policy after cancelling a holiday due to the death of Mrs C's close relative. Admiral rejected the claim under a pre-existing medical conditions exclusion that covered close relatives' conditions existing before the policy was taken out or the trip was booked. The ombudsman found the exclusion was clear, standard in the market, and properly disclosed. Since the relative had a terminal prognosis and was in hospice care when the holiday was booked, the claim fell within the exclusion. The ombudsman rejected arguments that Admiral's pre-claim advice was misleading and upheld Admiral's decision not to pay the claim.

The Ombudsman's reasoning

The ombudsman found that the pre-existing medical conditions exclusion was clear, standard in the travel insurance market, and properly highlighted in the product information. The exclusion explicitly covered pre-existing conditions of close relatives regardless of whether the policyholder knew about them. Since the relative had a terminal prognosis when the holiday was booked, the claim fell squarely within the exclusion. The ombudsman rejected arguments that Admiral's comments during the call were misleading, finding they were appropriately cautious and did not override the clear policy terms. Even if Admiral had given inaccurate information, the ombudsman noted that alternative arrangements (returning early for the funeral) would likely also have incurred uninsured costs.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website