Upheld: unfair claim rejection; failure to apply CIDRA remedies correctly complaint against Admiral Insurance (Gibraltar) Limited
Financial Ombudsman decision DRN-6359647 of 2026-06-05T00:00:00+00:00. unfair claim rejection; failure to apply CIDRA remedies correctly complaint against Admiral Insurance (Gibraltar) Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6359647 |
|---|---|
| Decision date | 2026-06-05T00:00:00+00:00 |
| Firm | Admiral Insurance (Gibraltar) Limited |
| Product | Travel insurance |
| Claim type | unfair claim rejection; failure to apply CIDRA remedies correctly |
| Outcome | Upheld |
| Remedy | Admiral must pay Mrs T's claim subject to applicable policy excess and limits, less any premium refund previously given, plus interest at 8% simple per annum from the date Mrs T paid the additional costs until settlement date. |
Summary
Mrs T claimed on her travel insurance policy for medical bills and additional flight costs incurred during an emergency surgery abroad. Admiral declined the claim citing a pre-existing medical conditions exclusion, noting Mrs T had failed to disclose medical consultations and treatment from the previous year at policy renewal. The ombudsman upheld the complaint, finding that while Mrs T's non-disclosure was careless, Admiral could not rely on the policy exclusion because it failed to demonstrate a qualifying misrepresentation under CIDRA by providing no evidence of what additional premium it would have charged. Admiral was ordered to pay the claim plus interest, and the £100 compensation for delays in handling was deemed fair.
The Ombudsman's reasoning
The ombudsman applied CIDRA principles, finding that while Mrs T failed to take reasonable care in not disclosing her medical issues at renewal (given Admiral's clear and specific questions), Admiral could not rely on the pre-existing conditions exclusion because it failed to demonstrate a qualifying misrepresentation. Specifically, Admiral could not show it would have refused the policy or offered different terms without evidence of what additional premium it would have charged. Therefore, Admiral's only available remedies under CIDRA were unavailable, and it was unfair to decline the claim based on the policy exclusion.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Admiral Insurance (Gibraltar) Limited, all decisions | 1,925 | 44% |
| Travel insurance, all decisions | 7,560 | 37% |
Source
Read the original decision on the Financial Ombudsman Service website