Not upheld: claims handling, coverage decision, service failures complaint against UK Insurance Limited

Decision detail

Summary

Mr and Mrs G complained to the FOS about UK Insurance Limited's handling of a travel insurance claim when Mrs G became unwell abroad and required hospitalization. UKI initially indicated cover was available but later declined the claim, linking the admission to a pre-existing excluded condition. Mr and Mrs G sought an additional £12,500 towards air ambulance repatriation costs, arguing that earlier notification of the coverage decision would have allowed earlier repatriation. The ombudsman found UKI acted reasonably in relying on initial hospital information and that medical evidence did not support earlier repatriation was possible. The complaint was not upheld, and the £750 compensation already paid was deemed sufficient.

The Ombudsman's reasoning

The ombudsman found that UKI acted reasonably in relying on the initial hospital information indicating the admission was unrelated to pre-existing conditions. While UKI could have better managed expectations about ongoing review of cover, the ombudsman determined that UKI was not obligated to proactively probe for reasons to decline a claim. The medical evidence did not support that Mrs G could have been repatriated earlier, so the delay in communicating the decision did not cause material financial detriment. The £750 compensation already paid was deemed fair for the distress and poor communication caused.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website