Partially upheld: claim declined - pre-existing condition exclusion complaint against Wakam

Decision detail

Summary

Ms Z complained that Wakam declined a claim on her pet insurance policy for her dog's loss of appetite. She had upgraded her policy on 6 May 2025 from a 'Value Policy' (£3,000 cover) to a 'Complete Care' policy (£15,000 cover), and visited the vet the same day. Wakam initially declined the claim on the basis it was made within 14 days of the new policy, but later declined it as a pre-existing condition since symptoms had started before the new policy commenced. The ombudsman found that while Wakam's initial reason for declining was incorrect, the claim was fairly declined as a pre-existing condition because Wakam had clearly explained this exclusion during the upgrade call and Ms Z was aware symptoms were present before the new policy started. The complaint was partially upheld, with compensation increased from £75 to £150 for the distress caused by the initial incorrect decline.

The Ombudsman's reasoning

The ombudsman found that while Wakam initially declined the claim for the wrong reason (the 14-day exclusion did not apply due to continuous cover), the claim was ultimately fairly declined as a pre-existing condition. The symptoms were present before the new policy started on 6 May 2025, and Wakam had clearly explained during the upgrade call that pre-existing conditions would not be covered. Ms Z was aware of the symptoms before the new policy commenced and proceeded with the upgrade on that basis. However, the initial incorrect reason for declining the claim caused distress and inconvenience, warranting increased compensation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website