Upheld: Travel / life insurance claim disputes complaint against Casualty & General Insurance Company (Europe) Ltd

Decision detail

Summary

Mrs U purchased pet insurance for her dog in January 2024. In November 2025, the dog required surgery to remove an anal gland following an infection. Casualty & General declined the claim, citing a pre-existing condition exclusion based on the dog's history of regular anal gland expressions before the policy started. The ombudsman upheld the complaint, finding that routine anal gland expressions without abnormalities or infections did not constitute a pre-existing condition, and that the infection and abscessation requiring surgery in 2025 represented a different condition that developed after the policy commenced. The ombudsman directed the firm to pay the claim with interest and £150 compensation.

The Ombudsman's reasoning

The ombudsman distinguished between routine anal gland expression (which occurred before the policy) and the infection/abscessation that required surgery (which occurred after the policy started). The key distinction was that the clinical notes showed no abnormalities or infections before the policy started - only routine maintenance. The infection and abscessation in 2025 represented a different condition that developed over a year after the policy commenced. The ombudsman found that Mrs U had no reason to be concerned before the policy started, as there were no abnormalities detected and it was not causing problems. Therefore, it was not fair to apply the pre-existing condition exclusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website