Not upheld: claim rejection and handling complaint against AWP P&C S.A.

Decision detail

Summary

Mr H, a British national living abroad, complained about AWP's rejection of his claim for remedial sinusitis surgery during a UK holiday. AWP covered diagnostic tests and initial treatment but rejected the surgery claim, stating it was not an emergency and could be delayed until Mr H returned home. The treating consultant confirmed the surgery was elective and could be deferred. The ombudsman found that AWP properly applied the policy terms, which explicitly exclude non-emergency treatment that can be reasonably delayed, and that the £200 compensation for service issues was fair. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the standard policy terms for travel insurance which provide cover for emergency treatment only. The policy explicitly excludes treatment or surgery that can be reasonably delayed until the policyholder returns home. The treating consultant confirmed the surgery was elective and could be deferred. Although the consultant advised against flying, this did not make the surgery an emergency or urgent treatment. AWP properly assessed the medical evidence and fairly applied the policy terms in rejecting the claim for surgery. The £200 compensation for service issues was appropriate.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website