Not upheld: claims handling delay and claim declination for insufficient medical evidence complaint against Inter Partner Assistance SA (IPA)

Decision detail

Summary

Mr M claimed on his travel insurance policy after cancelling a trip due to illness on 9 May 2025. IPA delayed processing the claim by approximately nine weeks and initially requested two years of medical history, which it later acknowledged was unreasonable. IPA offered £100 compensation for this delay. IPA subsequently declined the claim, first in December 2025 due to missing medical history, and again in January 2026 due to insufficient evidence that Mr M was medically unfit to travel. The ombudsman found the £100 compensation for the delay was reasonable but upheld the claim declination because Mr M failed to provide the medical evidence required by the policy—a certificate from a treating practitioner confirming medical necessity to cancel—as he was not examined by any medical professional on the date he claims to have become ill and the GP explicitly stated he did not advise cancellation.

The Ombudsman's reasoning

The ombudsman applied the FCA's ICOBS requirements for prompt and fair claims handling. On the delay issue, the ombudsman found £100 compensation proportionate given the nine-week delay and administrative errors. On the claim declination, the ombudsman found that while the policy does cover cancellation due to illness, it requires specific evidential standards to be met. The policy explicitly requires a medical certificate from a treating practitioner stating that illness 'necessarily and reasonably prevented' travel. The ombudsman found that Mr M failed to meet this requirement because: (1) he was not examined by any medical professional on 9 May 2025 when he claims to have become ill; (2) the GP's medical certificate explicitly stated the GP did not advise cancellation, was not asked, and did not certify Mr M was unfit to fly; and (3) the subsequent medical records only reference the illness retrospectively. The ombudsman concluded it was reasonable for IPA to require evidence demonstrating medical unfitness to travel on the specific date, which Mr M had not provided.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website