Not upheld: claims handling delays and unfair claim denial complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Mr M claimed on a travel insurance policy after suffering a leg fracture requiring surgery while abroad in August 2025. IPA declined his personal accident claim in November 2025, finding the injury did not meet the policy definition requiring death, loss of limb, loss of sight, or permanent total disablement within 12 months. IPA paid £50 compensation for delays in handling the claim. Mr M complained that IPA should have directed him to make a medical expenses claim and that the compensation was inadequate. The ombudsman found IPA's decision to decline the personal accident claim was reasonable based on the medical evidence and policy terms, and that the £50 compensation was fair for the claims handling delays.

The Ombudsman's reasoning

The ombudsman found that IPA's policy terms clearly required that personal accident benefit only be payable if the accident resulted in death, loss of sight or limb, or permanent total disablement within 12 months. The medical evidence showed Mr M's leg required surgery but did not evidence limb loss, and 12 months had not elapsed to assess permanent total disablement. IPA's conclusion that the claim did not meet policy terms was reasonable. Regarding claims handling, while IPA caused delays between 1 September and 12 November 2025, the £50 compensation was fair and proportionate because ultimately the claim was not payable and Mr M was not denied access to money he was entitled to.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website