Upheld: unfair application of late claims time limit condition; unreasonable claim rejection complaint against Wakam
Financial Ombudsman decision DRN-6269614 of 2026-04-24T00:00:00+00:00. unfair application of late claims time limit condition; unreasonable claim rejection complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6269614 |
|---|---|
| Decision date | 2026-04-24T00:00:00+00:00 |
| Firm | Wakam |
| Product | pet insurance |
| Claim type | unfair application of late claims time limit condition; unreasonable claim rejection |
| Outcome | Upheld |
| Remedy | Wakam must pay: (1) the late claim deductions made to Mr G's claims plus simple interest calculated using time-weighted average of Bank of England base rate plus one percentage point from 5 January 2026 (date claims accepted) to settlement date; (2) £100 compensation for distress and inconvenience. Payment must be made within 28 calendar days of notification of Mr G's acceptance. If payment is not made by the deadline, 8% simple interest per year applies to the late claim deductions from the deadline date to settlement date. |
Summary
Mr G submitted a claim for pet insurance covering treatment from April 2024 to November 2025, but delayed submission until December 2025. Wakam split the claim across two policy years and applied time limit deductions (12 months for 2024/25 and 6 months for 2025/26), resulting in reimbursement of only £17. The ombudsman upheld Mr G's complaint, finding that while time limit conditions are legitimate, Wakam failed to demonstrate actual prejudice from the delay. The ombudsman ordered Wakam to repay the late claim deductions with interest plus £100 compensation for distress and inconvenience.
The Ombudsman's reasoning
The ombudsman accepted that time limit conditions serve legitimate operational purposes and that splitting claims across two policy years was fair. However, the ombudsman applied the FOS's usual approach to procedural breaches: assessing whether the insurer suffered actual prejudice. Wakam failed to demonstrate that Mr G's delay caused any disadvantage or impaired its ability to investigate or assess the claims. The ombudsman found that if the claims had been submitted on time, they would likely have been assessed and paid in the same way. Therefore, Wakam acted unfairly by rejecting the claims on a technicality without showing increased risk exposure.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam, all decisions | 263 | 51% |
Source
Read the original decision on the Financial Ombudsman Service website