Upheld: Travel / life insurance claim disputes complaint against Wakam
Financial Ombudsman decision DRN-6388272 of 2026-06-26T00:00:00+00:00. Travel / life insurance claim disputes complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6388272 |
|---|---|
| Decision date | 2026-06-26T00:00:00+00:00 |
| Firm | Wakam |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Wakam must: (1) pay Miss B's claim subject to remaining policy terms; (2) pay interest on the claim from the date Miss B paid veterinary fees using simple interest and the time-weighted average method; (3) provide a tax deduction certificate; (4) pay £100 compensation for stress and inconvenience caused by the incorrect claim decline. Wakam is advised that future claims for surgery arising from this cruciate ligament problem are likely to be payable. |
Summary
Miss B claimed on her pet insurance policy for an x-ray investigating cruciate ligament disease in December 2025. Wakam declined the claim, asserting that the pet had shown signs of the condition in June 2024 when it presented with lameness in its back right leg, thereby triggering the pre-existing condition exclusion. The ombudsman upheld Miss B's complaint, finding that Wakam failed to provide clinical evidence demonstrating a connection between the two episodes separated by 16 months. The ombudsman ordered Wakam to pay the claim with interest and £100 compensation, and advised that future related surgery claims would likely also be payable.
The Ombudsman's reasoning
The onus is on Wakam to demonstrate on balance that the pre-existing condition exclusion applies. The firm failed to provide clinical evidence supporting a connection between the June 2024 lameness and the October 2025 cruciate ligament disease. The 16-month gap, the one-off nature of the earlier episode, the lack of any concerns raised during subsequent vet visits, and the reasonable knowledge standard all weigh against the exclusion applying. Miss B could not reasonably have anticipated that a resolved lameness episode from a year before taking out the policy would require further investigation.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Wakam, all decisions | 269 | 51% |
| Travel / life insurance claim disputes, all decisions | 20,052 | 31% |
| Other regulated product, all decisions | 47,449 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website