Inter Partner Assistance SA · DRN-6244948

The complaint Mr and Mrs M are unhappy that Inter Partner Assistance SA have declined a claim they made on their travel insurance policy. What happened Mrs M was admitted to hospital during a holiday which meant Mr and Mrs M missed their original return flights as they had to stay abroad. They claimed on their travel insurance policy but the claim was declined as IPA said Mr and Mrs M hadn’t declared a number of medical conditions. During the claims process Mr and Mrs M were given mixed messages about whether they could claim on the policy as IPA accepted that some of the conditions they initially thought needed to be screened could be disregarded. Ultimately, IPA maintained their decision not to pay the claim but paid £100 compensation for the delays and confusion caused. Unhappy, Mr and Mrs M referred their complaint to the Financial Ombudsman Service. Our investigator looked into what happened. He upheld the complaint as he didn’t think IPA had sufficiently demonstrated they’d acted fairly and in line with the relevant legislation. He also recommended IPA pay £250 compensation for the distress and inconvenience caused to Mr and Mrs M during the claims process. IPA didn’t agree and asked an ombudsman to review the complaint. They said they’d provided all the information they could in support of the fact that no policy would have been offered to Mr and Mrs M. So, the complaint was referred to me to make a decision. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. The relevant law in this case is The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA). This requires consumers to take reasonable care not to make a misrepresentation when taking out a consumer insurance contract (a policy). The standard of care is that of a reasonable consumer. And if a consumer fails to do this, the insurer has certain remedies provided the misrepresentation is - what CIDRA describes as - a qualifying misrepresentation. For it to be a qualifying misrepresentation the insurer has to show it would have offered the policy on different terms or not at all if the consumer hadn’t made the misrepresentation. CIDRA sets out a number of considerations for deciding whether the consumer failed to take reasonable care. And the remedy available to the insurer under CIDRA depends on whether the qualifying misrepresentation was deliberate or reckless, or careless.

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IPA says Mr and Mrs M failed to take reasonable care when they answered questions about Mrs M’s medical history during the application process. IPA’s final position was that Mrs M didn’t disclose thrombosis and left ventricular dysfunction. I’m upholding Mr and Mrs M’s complaint because IPA hasn’t provided a clear and coherent overview of the sales process as it was presented to Mr and Mrs M. So, I’m not satisfied they’ve demonstrated there was a misrepresentation to the questions asked. Whilst they’ve provided some information, including various screenshots, it hasn’t clearly demonstrated the various steps of the sales process that I need to see in order to satisfy myself that Mr and Mrs M have been treated fairly. And, for the reasons I’ll go on to explain, I also think there are other reasons to uphold this complaint. Even if I was satisfied that there was a misrepresentation in response to the questions asked I’m not persuaded IPA have demonstrated it is a qualifying one. IPA says that they wouldn’t have offered a policy to Mr and Mrs M. But they haven’t clearly and persuasively demonstrated that. Whilst IPA provided some evidence about the information that was inputted during the retro-screening they haven’t clearly presented information demonstrating that the conditions would have led to the policy not being offered. Our investigator explained to IPA on a number of occasions what information he needed to see and why the evidence provided wasn’t satisfactory in the circumstances of this case. I don’t think IPA provided an adequate response or addressed those concerns in enough detail. So, I’m not persuaded that the misrepresentation, if it occurred, was a qualifying one in the way IPA has suggested. As IPA hasn’t shown that it’s most likely a policy wouldn’t have been offered I don’t think it’s fair and reasonable for them to apply the remedy applying to careless misrepresentation under CIDRA. So, I don’t think IPA have acted fairly by declining the claim. I therefore think they need to settle the claim in line with the remaining policy terms. Mr and Mrs M have had a difficult and frustrating claims experience. They’ve repeatedly given mixed messages and had to chase up what was happening. The relevant rules and industry guidelines say IPA has a responsibility to handle claims promptly and fairly. I don’t think that’s what happened here. I think IPA needs to pay £250 compensation in recognition of the impact of this experience on Mr and Mrs M. I’m satisfied they were caused avoidable distress and inconvenience during the claims process. Putting things right IPA needs to put things right by: • Settling the claim in line with the remaining policy terms and conditions. They should also pay 8% simple interest on the settlement from one month after the claim was submitted until the date of settlement. If IPA considers it’s required by HM Revenue & Customs to take off income tax from any interest paid, it should tell Mr and Mrs M how much it’s taken off. It should also give them a certificate showing this if they ask for one. That way Mr and Mrs M can reclaim the tax from HM Revenue & Customs, if appropriate. • Paying £250 compensation for the distress and inconvenience caused. That’s in addition to any payment that’s already been made. My final decision I’m upholding this complaint and direct Inter Partner Assistance SA to put things right in the way I’ve outlined above.

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Under the rules of the Financial Ombudsman Service, I’m required to ask Mr and Mrs M to accept or reject my decision before 22 April 2026. Anna Wilshaw Ombudsman

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