Partially upheld: Home insurance claim disputes complaint against CIGNA Life Insurance Company of Europe SA-NV

Decision detail

Summary

Mr C claimed for two deep tissue massages at a hotel wellness centre under his group global healthcare policy. CIGNA declined the claim, citing that massages are not listed as covered treatments and the wellness centre location falls within the health spa exclusion. The ombudsman found the claim was fairly declined based on policy terms, but CIGNA had previously provided confusing information suggesting massotherapist treatment could be covered in principle. This contradiction caused Mr C unnecessary distress and inconvenience. The complaint was partially upheld with £50 compensation awarded for the confusing information, while the claim decline itself was upheld as fair.

The Ombudsman's reasoning

CIGNA fairly declined the claim because deep tissue massages are not listed as covered treatments under the policy benefits, and the wellness centre location falls within the specific exclusion for health spas. However, CIGNA provided confusing information to Mr C in July 2025 by suggesting massotherapist treatment could be covered in principle, which contradicted the policy terms and caused unnecessary distress and inconvenience when this was later contradicted. Compensation is appropriate to reflect this confusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website