Not upheld: claim decline based on fraud allegation; service delays complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Miss A and Mr K held a joint travel insurance policy with Admiral and submitted a claim for lost belongings. Miss A included an order confirmation from retailer X (totalling £1,700) as proof of purchase and claimed for items including trainers from that order. Admiral discovered the X order had been cancelled and refunded, meaning the items were not in Miss A's possession at the time of loss. Miss A claimed she had told Admiral the X order confirmation was sent in error, but Admiral had no recording or record of this conversation. The ombudsman found no evidence supported Miss A's account of this conversation and upheld Admiral's decision to decline the claim based on the policy's fraud terms, while finding the £100 compensation for service delays was adequate.

The Ombudsman's reasoning

The ombudsman found that Miss A submitted documents and claimed for items which were no longer in her possession and for which she had received a refund. While Miss A claimed she had told Admiral the order confirmation was sent in error, there was no telephone recording or record of this conversation in Admiral's notes. The ombudsman was not persuaded this conversation took place and found it more likely Miss A attempted to speak to Admiral but was unable to do so. Given the evidence, it was not unreasonable for Admiral to rely on the policy fraud terms to decline the claim. The ombudsman rejected Mr K's request for separate consideration as he was a policyholder and many claimed items were his own.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website