Upheld: Travel / life insurance claim disputes complaint against Casualty & General Insurance Company (Europe) Ltd

Decision detail

Summary

Miss G purchased pet insurance for her cat on 27 September 2025. In December 2025, the cat developed ocular melanoma requiring eye removal surgery, and in January 2026 the cat was euthanised due to deterioration. Casualty & General declined both claims citing pre-existing condition exclusion, arguing that eye colour changes noted in clinical records since 2021 constituted a pre-existing condition. The ombudsman upheld the complaint, finding that while the medical condition was present before the policy started, Miss G was not aware it would require treatment, as the clinical notes consistently indicated no abnormalities or problems. The vet confirmed the sudden changes in December 2025 were distinctly different from previous changes. The ombudsman directed Casualty & General to pay both claims with interest.

The Ombudsman's reasoning

The ombudsman acknowledged that while the medical condition was present before the policy started, fairness requires consideration of what Miss G knew or should have known. The clinical evidence showed the eye colour changes were benign, caused no problems, and the vet did not recommend investigation or treatment. The sudden changes in December 2025 were confirmed by the vet as distinctly different from the previous changes. Therefore, Miss G had no reasonable basis to anticipate that treatment would be needed when she purchased the policy, making it unfair to apply the pre-existing condition exclusion strictly.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website