Not upheld: Travel / life insurance claim disputes complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Mr W claimed on his annual multi-trip travel insurance policy after cancelling a ski holiday due to his wife's miscarriage. Admiral declined the claim because Mr W had not purchased optional winter sports cover, which was required for any winter sports trip. The ombudsman found the trip was clearly a winter sports trip based on booking through a specialist ski operator, the ski resort destination, and purchase of ski carriage. The policy terms and IPID were sufficiently clear about the exclusion, and this exclusion defined the scope of cover purchased rather than constituting a breach of policy terms. The ombudsman upheld Admiral's reliance on the exclusion as fair and reasonable, and found the £350 compensation already paid for poor claim handling to be appropriate.

The Ombudsman's reasoning

The ombudsman found that the trip was clearly a winter sports trip based on the booking through a specialist ski operator, the ski resort destination, peak ski season timing, and purchase of ski carriage. The policy terms and IPID were sufficiently clear that winter sports trips were excluded unless the optional cover was purchased. Section 11 of the Insurance Act 2015 did not apply as this concerned the scope of cover purchased rather than a breach of policy terms. The winter sports exclusion is a common industry practice and fairly reflects the premium paid. The £350 compensation for poor claim handling was appropriate given the one-month timeframe and level of distress caused.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website