Not upheld: claim declined - insufficient evidence complaint against Inter Partner Assistance SA

Decision detail

Summary

Mr M claimed under his annual multi-trip travel insurance policy for a cancelled trip due to illness. IPA declined the claim, requesting a medical certificate from his treating practitioner to verify the condition was not pre-existing and that proper declarations had been made. Mr M provided a fitness to work form from his GP instead, arguing IPA had previously accepted this form on a COVID-related claim. The ombudsman found that requiring a medical certificate is a standard policy requirement and that the fitness to work form lacked sufficient detail for IPA's assessment purposes. The ombudsman distinguished the earlier COVID claim and upheld IPA's decision to apply its policy terms consistently, finding the firm's alternative offer to reconsider with medical history was reasonable.

The Ombudsman's reasoning

The ombudsman found that requiring a medical certificate for trip cancellation claims due to illness is a standard and reasonable policy requirement. The fitness to work form, while accepted for a COVID claim, did not contain sufficient information to allow IPA to assess whether the condition was pre-existing or whether proper declarations had been made at inception. The ombudsman distinguished the earlier COVID claim as unrelated to pre-existing conditions, explaining why IPA's acceptance of different evidence on that occasion did not make it unreasonable to apply the policy terms to the current claim. The ombudsman also found IPA's alternative suggestion to provide medical history was reasonable.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website