Not upheld: claim declined - non-disclosure of pre-existing medical conditions; alleged mis-information regarding claim approval complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Mr and Mrs A purchased a single trip travel insurance policy from IPA for a trip to Europe in August 2025. When Mr A required surgery before the trip, they made a cancellation claim, which IPA declined on the grounds that Mr A had failed to disclose pre-existing medical conditions (hypertension, chronic headaches, and LBBB). The ombudsman upheld IPA's decision, finding that Mr and Mrs A failed to take reasonable care when answering medical disclosure questions and that the non-disclosure constituted a qualifying misrepresentation under CIDRA. IPA's remedy of cancelling the policy and refunding the premium was found to be fair and appropriate for careless misrepresentation. The ombudsman also rejected Mrs A's complaint about alleged mis-information regarding claim approval.

The Ombudsman's reasoning

The ombudsman applied CIDRA, which requires consumers to take reasonable care not to make misrepresentations when taking out insurance. The ombudsman found that Mr and Mrs A failed to take reasonable care in answering the medical disclosure questions, as they answered negatively despite Mr A having received treatment for hypertension, chronic headaches, and LBBB. IPA demonstrated it would not have offered the policy had these conditions been disclosed, making this a qualifying misrepresentation. IPA's remedy of cancellation and premium refund was appropriate for careless misrepresentation under CIDRA. Regarding Mrs A's complaint about incorrect information, the ombudsman found she was not specifically told the claim was approved and was not persuaded she cancelled the holiday in reliance on IPA's statements.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website