Inter Partner Assistance SA · DRN-6162109

The complaint Mr G is unhappy that Inter Partner Assistance SA have declined a claim he made on his travel insurance policy. What happened Mr G became unwell with appendicitis whilst he was on holiday. He contacted his insurer but they declined the claim because they said Mr G hadn’t accurately disclosed his medical history. They said, had he done so, they wouldn’t have offered him this policy. Mr G complained to IPA but they maintained their decision was fair, and in line with the relevant legislation. They did pay Mr G £25 compensation for a customer service issue as Mr G was sent the wrong policy terms. Unhappy, Mr G complained to the Financial Ombudsman Service. Our investigator looked into what happened and didn’t uphold the complaint. He thought IPA had acted reasonably as Mr G wouldn’t have been sold the policy if he’d disclosed the right information about his medical history. Mr G didn’t agree and asked an ombudsman to review the complaint. In summary, he highlighted that the procedure he’d not disclosed had been done privately and the requirements under The Consumer Duty for IPA to avoid foreseeable harm. He also said that IPA offered two similar policies, one which offered cover for pre-existing medical conditions and one that didn’t. Finally, he said that the remedy applied by IPA wasn’t proportionate. So, the complaint was passed 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. IPA says Mr G failed to take reasonable care when he answered questions about his medical history during the application process. So, I’ve looked at the questions he was

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asked. They include the following questions: • Do any of these travellers have a pre-existing medical conditions? We need to know about any condition, even minor one, that you’ve seen a doctor about in the past 2 years. • Within the last 2 years has anyone you wish to insure on this policy suffered any medical condition, (medical or psychological disease, condition, illness or injury) that has required prescribed medication (including repeat prescriptions) and/or treatment including surgery, tests or investigations? Under the second question it went on to say that if the person wanting to take out insurance was unable to answer ‘no’ to the question then they’d need to request a quote for policies that cover pre-existing medical conditions. Mr G answered ‘no’ to both questions. I’m satisfied that he ought to have answered ‘yes’ as he’d visited his GP and a specialist which led to him having a surgical procedure within the relevant timeframe. I appreciate that the procedure was carried out privately but I think the questions made it sufficiently clear that IPA needed to know about all conditions within the last two year, however minor they were. IPA has provided underwriting evidence that Mr G wouldn’t have been eligible to take out the policy if he’d answered ‘yes’ to the above questions. That’s because the policy isn’t designed for people with pre-existing medical conditions. Instead he’d have been directed to other policies which offered cover for people who had experienced medical conditions within the last two years. Mr G’s comments about the dual policy model haven’t changed my thoughts about the outcome of the complaint. IPA is entitled to offer different policies and different cover options. I’ve also taken into account the Consumer Duty principles, including the points Mr G has raised about foreseeable harm. But, as I’ve outlined above, I think the information provided made it clear that anyone who had experienced any form of medical condition within two years needed to select the option for cover with pre-existing medical conditions. So these points haven’t changed my thoughts about the overall outcome of this complaint. This means I’m satisfied that Mr G’s misrepresentation was a qualifying one. IPA has said Mr G’s misrepresentation was careless. I agree that’s fair as I think Mr G overlooked the significance of his treatment during the application process. I don’t think he sought to deliberately mislead them. As I’m satisfied that Mr G’s misrepresentation should be treated as careless I’ve looked at the actions IPA can take in accordance with CIDRA. In such circumstances IPA is entitled to decline the claim, cancel the policy and refund the premium. That’s what they’ve agreed to do and I think that’s in line with the remedy set out in CIDRA. I appreciate that IPA do offer cover for medical conditions under other policies. However, there was no form of cover for this specific type of policy. Mr G would have been directed to IPA’s ‘select’ policies and would have undergone a medical screening. That means the policy is underwritten in a different way and therefore it’s not fair and reasonable to direct IPA to make a proportionate settlement in the circumstances of this case. Taking into account all of the above I’m satisfied that IPA has acted fairly and reasonably in all the circumstances. Finally, I note IPA did award compensation for the wrong information being provided to Mr G.

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For completeness, I think the £25 compensation already paid fairly reflects the impact on Mr G as I can appreciate it would have been frustrating to be sent the wrong information and that would have caused a degree of distress and inconvenience. My final decision I’m not upholding this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr G to accept or reject my decision before 22 April 2026. Anna Wilshaw Ombudsman

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