Not upheld: claim decline - exclusion application complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Miss A held an annual travel insurance policy with Admiral and became unwell during a hike up Mountain R (above 4000m altitude) while on a trip in September 2025. She submitted a medical assistance claim which Admiral declined, citing the policy's exclusion for hiking above 4000m. Miss A complained that her symptoms had begun before the hike, Admiral delayed sending written confirmation, and the medical assistance team was unhelpful. Admiral acknowledged the delay and paid £50 compensation but maintained the claim decline. The ombudsman found the decline was not unreasonable as the policy clearly excluded the activity, and upheld the £50 compensation as fair and proportionate for the service failing.

The Ombudsman's reasoning

The ombudsman found that Admiral's decline was not unreasonable because the policy clearly excluded hiking above 4000m altitude, Mountain R exceeded that limit, and Miss A commenced an activity not covered by the policy before making a claim. Although Miss A's symptoms began below 4000m, the claim was made after she had already commenced the excluded activity. The ombudsman rejected arguments that not reaching the maximum altitude or pre-existing symptoms should change the outcome. Regarding compensation, the ombudsman found that while the delay in written communication was disappointing, Miss A had been verbally informed of the decline within three days and the written confirmation would not have changed the outcome or her liability for costs.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website