Not upheld: claim declined due to misrepresentation of medical history complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Mr W purchased an annual travel insurance policy in June 2024 and became unwell abroad in November 2024, requiring hospitalisation. He claimed on the policy for medical expenses, but IPA declined the claim, stating he had failed to disclose his full medical history when purchasing. Mr W had visited his GP four times between January 2023 and April 2024 but answered 'No' to two clear questions about medical history. The ombudsman found that IPA's questions were unambiguous and Mr W failed to take reasonable care in answering them, constituting a qualifying misrepresentation under CIDRA 2012. Since IPA demonstrated it would not have offered the policy with accurate information, the ombudsman upheld IPA's decision to decline the claim.

The Ombudsman's reasoning

The ombudsman found that IPA asked clear and unambiguous questions about medical history in the past two years. Mr W failed to take reasonable care in answering these questions, as he had visited his GP four times in the relevant period but answered 'No'. This constitutes a qualifying misrepresentation under CIDRA because IPA demonstrated it would not have offered this policy had the correct information been provided. Therefore, IPA was entitled to decline the claim under the relevant legislation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website