Upheld: Travel / life insurance claim disputes complaint against Wakam
Financial Ombudsman decision DRN-6421544 of 2026-06-24T00:00:00+00:00. Travel / life insurance claim disputes complaint against Wakam. Outcome: Upheld.
Decision detail
| Reference | DRN-6421544 |
|---|---|
| Decision date | 2026-06-24T00:00:00+00:00 |
| Firm | Wakam |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Upheld |
| Remedy | Wakam must: (1) pay Mr and Mrs J's claim subject to remaining policy terms; (2) pay interest on the claim amount from the date Mr and Mrs J paid their veterinary fees until reimbursement, calculated as simple interest using the time-weighted average method; (3) provide a tax deduction certificate; (4) pay £200 compensation for stress and inconvenience caused during a difficult personal time. |
Summary
Mr and Mrs J claimed on their pet insurance policy for elbow dysplasia treatment in October 2025. Wakam declined the claim, arguing it was a pre-existing condition because the pet had experienced shoulder lameness before the policy started in June 2025. The ombudsman upheld the complaint, finding that Wakam failed to demonstrate the two conditions were related. The treating veterinarian provided credible evidence that the shoulder lameness (January-April 2025) and elbow dysplasia (October 2025) were separate conditions, supported by clinical notes showing no elbow disease in February 2025. Wakam was ordered to pay the claim plus interest and £200 compensation.
The Ombudsman's reasoning
The ombudsman applied the burden of proof to Wakam, requiring them to demonstrate on balance that the pre-existing condition exclusion applied. Wakam failed to supply clinical evidence showing that the shoulder lameness and elbow dysplasia resulted from the same disease process. The ombudsman found the treating veterinarian's clinical opinion credible and well-supported by the clinical notes, which distinguished the two conditions despite both presenting as lameness in the same limb. The absence of subtrochlear sclerosis in February 2025 radiographs, combined with the six-month symptom-free period and different clinical findings, supported the conclusion that these were separate conditions.
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