Not upheld: claim declined - policy exclusion applied complaint against Inter Partner Assistance SA

Decision detail

Summary

Mr B and Miss S claimed on their travel insurance policy after cutting short a backpacking trip due to a family member's serious illness and purchasing emergency tickets to fly home. IPA declined the claim based on a policy exclusion that stated costs for returning home would not be covered if no return ticket had been purchased, unless agreed by the Emergency Medical Assistance Service. The ombudsman found the exclusion was clearly worded, not unusual or unfair, and that IPA was entitled to rely on it. Although there was minor delay in claim handling, the ombudsman found no evidence of unfair treatment and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman applied the regulatory requirement that insurers must handle claims promptly and fairly and must not turn down claims unreasonably. The policy exclusion was clearly worded and not unusual or unfair. Since Mr B and Miss S had not purchased a return ticket, IPA was not contractually bound to reimburse the costs incurred in purchasing tickets to fly home. The ombudsman found no reason for IPA to depart from the policy exclusion and no evidence of unfair or unreasonable treatment. While there was some delay in claim handling, the ombudsman found the service was not lacking overall.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website