Partially upheld: claim handling, benefit cap, medical emergency determination complaint against Zurich Insurance Company Ltd
Financial Ombudsman decision DRN-6273357 of 2026-04-20T00:00:00+00:00. claim handling, benefit cap, medical emergency determination complaint against Zurich Insurance Company Ltd. Outcome: Partially upheld.
Decision detail
| Reference | DRN-6273357 |
|---|---|
| Decision date | 2026-04-20T00:00:00+00:00 |
| Firm | Zurich Insurance Company Ltd |
| Product | travel insurance |
| Claim type | claim handling, benefit cap, medical emergency determination |
| Outcome | Partially upheld |
| Remedy | Zurich Insurance Company Ltd must: (1) Settle Mrs H's claim until 27 October 2025 including inpatient benefit for hospital stay from 24 October 2025 to 27 October 2025, with simple interest at 8% yearly from 27 October 2025 until settlement; (2) Pay Mrs H total compensation of £350. |
Summary
Mrs H complained that Zurich Insurance Company Ltd unfairly capped her travel insurance benefit after she suffered a significant injury abroad requiring surgery. Zurich admitted the claim but determined the injury did not meet the criteria for a 'time critical medical emergency' and recommended repatriation to the UK for surgery, capping benefit on 27 October 2025. Mrs H's treating specialist advised that flying was contraindicated due to risks of compartment syndrome and DVT, but Zurich's medical team determined repatriation was medically reasonable with appropriate support measures including business class seating. The ombudsman upheld the complaint in part, finding Zurich's decision to cap benefit was fair and reasonable, but increasing compensation from £250 to £350 for delays and communication issues, and confirming inpatient benefit was payable for Mrs H's hospital stay.
The Ombudsman's reasoning
The ombudsman found that Zurich was entitled to cap the benefit following the period it deemed Mrs H fit to fly home, as the policy terms explicitly state policyholders must accept Zurich's decisions about the most suitable, practical and reasonable solution to medical emergencies. Zurich's decision was made after considering Mrs H's medical evidence and consulting its own medical advisers, and was consistent with IATA guidelines for managing DVT risk through business class seating and anticoagulants. While the ombudsman acknowledged Mrs H's difficult position and her treating specialist's concerns, the medical evidence did not wholly support her contention that flying was unsafe. However, the ombudsman agreed that compensation should be increased to £350 due to the stress caused by delays and communication issues, particularly the timing of confirming its stance while Mrs H was in hospital.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Zurich Insurance Company Ltd, all decisions | 184 | 23% |
Source
Read the original decision on the Financial Ombudsman Service website