Upheld: unfair claim rejection - misapplication of pre-existing condition exclusion complaint against AWP P&C S.A.
Financial Ombudsman decision DRN-6386682 of 2026-06-02T00:00:00+00:00. unfair claim rejection - misapplication of pre-existing condition exclusion complaint against AWP P&C S.A.. Outcome: Upheld.
Decision detail
| Reference | DRN-6386682 |
|---|---|
| Decision date | 2026-06-02T00:00:00+00:00 |
| Firm | AWP P&C S.A. |
| Product | travel insurance |
| Claim type | unfair claim rejection - misapplication of pre-existing condition exclusion |
| Outcome | Upheld |
| Remedy | AWP must: (1) pay Mr and Mrs H's cancellation claim subject to any applicable policy excess and/or limits; (2) add interest at 8% simple per annum from one month after the date the claim was made until settlement; (3) pay £150 additional compensation for distress and inconvenience (in addition to the £100 already paid); (4) pay compensation within 28 days with interest at 8% per annum simple if paid later. |
Summary
Mr and Mrs H claimed on their travel insurance policy after Mrs H was advised not to travel due to requiring a pacemaker fitting. AWP declined the claim citing a pre-existing medical condition exclusion, relying on a May 2025 doctor's appointment that occurred before the policy was purchased. The ombudsman upheld the complaint, finding that AWP failed to establish a qualifying misrepresentation under CIDRA because: (1) at point of sale, AWP did not specify what questions were asked or what it would have done differently with the information; and (2) when Mrs H subsequently called to report a loop recorder fitting, AWP accepted cover without asking further questions, making it reasonable for Mrs H not to separately declare awaiting tests. The ombudsman ordered AWP to pay the claim with interest and £150 additional compensation.
The Ombudsman's reasoning
The ombudsman applied CIDRA, which requires consumers to take reasonable care not to make misrepresentations. For CIDRA remedies to apply, the insurer must show a qualifying misrepresentation occurred. The ombudsman found: (1) At point of sale, AWP failed to specify what questions were asked or what information should have been declared regarding the May 2025 appointment, and provided no evidence of what it would have done differently if informed. Therefore, Mrs H did not fail to take reasonable care. (2) During the subsequent telephone call, Mrs H specifically informed AWP about the loop recorder heart monitoring, and AWP accepted cover for this without asking further questions. It was not unreasonable for Mrs H to believe she did not need to separately declare awaiting tests/investigations, as AWP was already aware of the heart monitoring and there was no medical evidence she knew a pacemaker might be needed. Therefore, no qualifying misrepresentation occurred during the variation either. Since CIDRA remedies are unavailable to AWP, it cannot rely on the pre-existing condition exclusion to decline the claim.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| AWP P&C S.A., all decisions | 235 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website