Not upheld: unfair claim settlement and poor customer service complaint against Red Sands Insurance Company (Europe) Limited

Decision detail

Summary

Mr C claimed his pet insurance policy should have paid £3,500 towards his dog's veterinary treatment following a brain tumour diagnosis, but Red Sands only paid £1,154, leaving him to cover £4,100 out of pocket. The ombudsman reviewed the policy terms and found Red Sands correctly applied a £1,000 vet fee limit per condition and made fair deductions for the hypothyroidism claim. The ombudsman determined the vestibular symptoms were related to the brain tumour, justifying treatment as a single condition. While acknowledging Red Sands' poor communication, the ombudsman upheld the claim settlement as fair and reasonable, accepting Red Sands' offer of £175 compensation for service shortcomings.

The Ombudsman's reasoning

The ombudsman carefully reviewed the policy terms and found Red Sands' deductions for the hypothyroidism claim were fair and in line with policy limits. For the brain tumour, the ombudsman determined the vestibular symptoms were likely related to the brain tumour rather than a separate condition, making it reasonable to treat both claims as one condition subject to the £1,000 vet fee limit. Red Sands' payment of £1,000 total for brain tumour treatment was therefore compliant with policy terms. The euthanasia and cremation costs could not be paid beyond the already-exhausted £1,000 limit. The death benefit claim was initially fairly declined due to lack of proof of purchase, but the £175 offer (35% of £500 limit) was reasonable and fair compensation for service shortcomings.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website