Not upheld: claim settlement based on non-disclosure of medical information; failure to send renewal documentation complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Mrs P and Mr W complained to Admiral Insurance about the proportionate settlement of a travel insurance claim following Mrs P's injury and repatriation from holiday. Admiral settled the claim proportionately (66.74%) because Mrs P had failed to disclose two pre-existing medical conditions during policy renewal, despite being reminded to check medical information. Although Admiral failed to send renewal documentation, the ombudsman found this did not cause the non-disclosure, as the conditions were not disclosed on previous policies and a telephone reminder did not prompt disclosure. The ombudsman upheld Admiral's proportionate settlement under CIDRA 2012 as a fair remedy for careless misrepresentation and found the £100 compensation for the documentation failure to be adequate.

The Ombudsman's reasoning

Under CIDRA 2012, the ombudsman found that Mrs P and Mr W failed to take reasonable care by not disclosing pre-existing medical conditions during renewal. The ombudsman determined on the balance of probabilities that even if renewal documentation had been sent, the conditions would not have been disclosed, given they were not disclosed previously and the reminder during the phone call did not prompt disclosure. Admiral's treatment of this as a careless misrepresentation entitled them to proportionately settle the claim under CIDRA. The ombudsman was satisfied the proportionate settlement figure of 66.74% was correct and that the repatriation process was handled appropriately without unreasonable delays.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website