Not upheld: claim declined - non-disclosure of pre-existing medical condition complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Mr and Mrs C complained that IPA unfairly declined their travel insurance claim for medical expenses incurred abroad, arguing the claim was unrelated to Mr C's asthma and that his inhaler prescription was merely precautionary. IPA declined the claim because Mr C failed to disclose his asthma and prescribed medication when answering policy questions, despite being asked clearly about any prescribed medication in the previous two years. The ombudsman found the policy questions were clear and unambiguous, Mr C failed to take reasonable care in answering, and IPA would not have offered the policy had the asthma been disclosed. Under CIDRA, IPA was entitled to avoid the policy and refund premiums. The ombudsman upheld IPA's decision and confirmed the £50 compensation for minor claim handling delays was adequate.

The Ombudsman's reasoning

The ombudsman applied CIDRA and found that the policy questions were clear and unambiguous, requiring disclosure of any prescribed medication within the two-year period. Mr C failed to take reasonable care in answering 'no' when he had been prescribed inhalers for asthma. The ombudsman rejected Mr C's argument that the inhaler was precautionary, finding this did not change the obligation to disclose. The ombudsman was satisfied that had Mr C disclosed his asthma, IPA would not have offered the policy. The misrepresentation was careless rather than deliberate, entitling IPA to avoid the policy and refund premiums. The claim handling delay was not significant (August to October 2025) and the £50 compensation was adequate.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website