Not upheld: Travel / life insurance claim disputes complaint against AWP P&C S.A.

Decision detail

Summary

Miss L claimed on her travel insurance policy after cancelling a holiday booked in April 2023 when she discovered she was pregnant. She had experienced a miscarriage in 2022 and was anxious about the pregnancy. AWP declined the claim twice, stating the circumstances were not covered under the policy terms. Although the policy covered cancellation due to medical complications of pregnancy, it required a medical certificate confirming the claimant was medically unfit to travel. The medical certificate Miss L provided did not contain such confirmation or a doctor's recommendation against travel. The ombudsman found AWP had fairly declined the claim as the required medical evidence was absent, despite sympathising with Miss L's difficult circumstances.

The Ombudsman's reasoning

The ombudsman applied the test of whether the claim fell within the agreed areas of cover in the policy. The policy covered cancellation due to medical complications of pregnancy but required a medical certificate confirming the claimant was medically unfit to travel or that a doctor recommended she not travel. The medical certificate provided did not contain such a recommendation or confirmation. The ombudsman concluded that had the GP advised against travel, this would have been clearly expressed in the written medical records. The ombudsman rejected the argument that the absence of the phrase 'unfit to travel' was the reason for declination, finding instead that the substantive medical opinion recommending against travel was absent. The ombudsman found it reasonable for AWP to expect contemporaneous written medical advice rather than relying on the claimant's recollection of verbal advice given years earlier.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website