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

Decision detail

Summary

Miss H claimed cancellation of her travel insurance policy for a trip scheduled 28 April to 7 May 2025, citing illness with symptoms including breast pain, fever, vomiting and myalgia. IPA declined the claim stating cancellation was not medically necessary. Miss H's GP medical certificate explicitly stated the GP was not consulted prior to cancellation and would not certify the illness compelled it. A subsequent GP letter documented symptoms only from 12 May 2025, after the trip start date. The ombudsman found IPA reasonably concluded insufficient evidence demonstrated medical necessity for cancellation and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman applied the principle that firms should not unreasonably reject claims. The policy required medical certification that illness prevented travel. The GP's medical certificate explicitly stated they were not consulted before cancellation and would not certify the illness compelled cancellation. The subsequent GP letter only documented symptoms from 12 May 2025, after the trip's 28 April 2025 start date, providing no evidence of illness on the cancellation date. Therefore, IPA reasonably concluded insufficient evidence demonstrated medical necessity for cancellation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website