Inter Partner Assistance SA · DRN-6077656

The complaint Mr F and Ms R are unhappy that Inter Partner Assistance SA (IPA) declined their travel insurance claim. They’re also unhappy with how the claim was handled by IPA. What happened On 15 June 2025, Mr F and Ms R took out a single trip travel insurance policy, which was underwritten by IPA. The policy covered a trip from 19 June 2025 to 28 June 2025. While on their trip, Mr F and Ms R’s daughter became unwell, so they had to extend their trip as she wasn’t fit to fly. They contacted IPA’s medical assistance team. Mr F and Ms R said they were informed by IPA that their travel and accommodation costs would be covered. Once their daughter was confirmed fit to fly, Mr F and Ms R returned to the UK. Mr F and Ms R made a claim for their additional travel and accommodation costs. IPA declined their claim. It said the medical information received from their GP showed that their daughter had pre-existing medical conditions which weren’t disclosed at the time they took out the policy. There was no cover for the costs Mr F and Ms R incurred. Mr F and Ms R made a complaint to IPA. It maintained its position to decline their claim. and refunded the premium Mr F and Ms R. Unhappy, they brought their complaint to this service. At this point, IPA offered Mr F and Ms R £75 compensation for the service provided and to refund the policy premium to them. Our investigator partially upheld the complaint. She thought IPA declined the claim fairly, but she recommended £250 compensation for the service provided and for the distress and inconvenience caused to Mr F and Ms R. IPA accepted the investigator’s findings. Mr F and Ms R disagreed and asked for the complaint to be referred to an ombudsman. 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. At the outset, I acknowledge that Mr F and Ms R experienced a challenging time in dealing with their daughter’s health situation and for having to re-organise their travel and accommodation while abroad. It’s clear that it was upsetting and distressing for them. I’m sorry for this. I also fully appreciate Mr F and Ms R’s strength of feeling on the matter and I want to reassure them that I’ve seen and considered the submissions they have provided about their complaint. But it is important to point out that we’re an informal dispute resolution service, set up as a free alternative to the courts for consumers. In deciding this complaint I’ve focused on what I consider to be the heart of the matter rather than commenting on every

-- 1 of 5 --

issue or point made in turn. This isn’t intended as a discourtesy to Mr F and Ms R. Rather it reflects the informal nature of our service, its remit, and my role in it. Has the claim been declined fairly? 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 must 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. I’ve gone on to think about this when looking at Mr F and Ms R’s complaint and their individual circumstances. IPA said Mr F and Ms R didn’t disclose all the medical information for their daughter that they should have when they took the travel insurance policy. IPA requested medical information from Mr F and Ms R’s GP as part of the claim validation process. It said their daughter’s medical history hadn’t been declared. The application for the policy asked a number of questions. One of the questions Mr F and Ms R were required to answer was: ‘Within the last 2 years, has anyone you wish to insure on this policy suffered any medical or psychological condition, disease, sickness, illness or injury that has required prescribed medication (including repeat prescriptions) or treatment including surgery, tests or investigations?’ They answered ‘No’ to this question. During the process of taking out the policy, IPA has shown, the following question was also asked: ‘Do any travellers have, or have any travellers had any pre-existing medical conditions or is anyone on a waiting list for treatment or investigation?’ Mr F and Ms R answered ‘No’ to this question. I think both questions were clear. In the policy terms and conditions on page 3, it states: ‘Demands and Needs Statement Single trip – This policy meets the Demands and Needs of a customer wishing to buy a standard travel insurance policy covering one trip, who has not suffered a medical condition nor required prescribed medication, surgery, treatment, tests or investigations within the two years leading up to the policy purchase date.’ The medical records IPA has provided show that Mr F and Ms R’s daughter had medical

-- 2 of 5 --

treatment and medication in the two years leading up to the policy purchase date of 15 June 2025. Examples of this, taken from the GP medical records, includes, viral upper respiratory tract infection, tubulointerstitial nephritis, tonsillectomy and adenoidectomy. And I can see their daughter was prescribed medication for treating these conditions during the same period. I’ve carefully considered the questions that were asked. Having done so, I think they were clear and specific. Bearing in mind the medical records provided by the GP surgery, it’s reasonable to think that the questions weren’t answered accurately. As such, I consider that there were pre-existing medical questions which weren’t disclosed at the time of taking out the policy. IPA has classified the qualifying misrepresentation as a careless one (as opposed to deliberate or reckless). IPA has provided evidence which shows what would have happened if the correct information was entered at the time the policy was taken out. It shows that had Mr F and Ms R completed the questions accurately; IPA wouldn’t have provided cover at all. This means, I’m satisfied that Mr F and Ms R’s misrepresentation was a qualifying one. CIDRA sets out the remedies available to an insurer in the case of careless misrepresentation. CIDRA is concerned with disclosure and representations made by a consumer to an insurer before a consumer contract is entered into or varied. In this case, IPA said the misrepresentation was a careless one. As a result, it refunded the premium Mr F and Ms R paid for the policy and cancelled the policy from the start. I note Ms R’s comments that the condition their daughter experienced while on the trip only occurs once. However, the claim was declined because the GP records showed pre-existing medical conditions that should have been disclosed when the policy was taken out. So, regardless of the condition their daughter developed during the trip, those pre-existing conditions ought to have been declared. I do understand Mr F and Ms R will be disappointed. But IPA has followed the law as set out in CIDRA and declined their claim. Taking everything into account, I’m satisfied this is fair and reasonable and in line with the rules set out by the industry regulator and in line with industry guidance. For the reasons given, it follows that I don’t require IPA to do anything further on this issue. Claim-handling Based on what I’ve seen, I understand that IPA could have provided clearer information about the claim Mr F and Ms R were making and could have managed their expectations better. IPA has accepted that there were delays and that the service it provided could have been better. This isn’t in dispute. The question, therefore, is what level of compensation is fair in the circumstances of this complaint. IPA initially offered £75 compensation. Following our investigator’s recommendation, it agreed to increase this to £250 for the service it provided. Having reviewed all the evidence and listened to the call recordings, I agree that IPA’s communication could have been clearer. Mr F and Ms R were seeking assistance while abroad because their daughter was unwell. Ms R kept IPA updated throughout and provided all the information IPA needed to assess the claim. For the most part, it was Ms R who had

-- 3 of 5 --

to call IPA for updates and assistance. I can understand why Mr F and Ms R were disappointed when their claim was later declined. However, I also note that IPA didn’t confirm that the claim would definitely be paid. It explained that it needed information to assess the claim, which is not unusual in these circumstances. Even so, I consider that IPA could have communicated more clearly about the claims process and the steps involved. While the advisors didn’t state the claim would be approved, the way IPA requested information led Mr F and Ms R to believe their claim was likely to be accepted. In my view, IPA wasn’t sufficiently clear in explaining the process or in managing their expectations about how the claim would be validated. IPA acknowledged that it could have reached a decision on the claim sooner and, in doing so, might not have needed to request all the documents it did. In recognition of this, it initially offered £75 compensation and later agreed to pay £250 following our investigator’s recommendation. I accept that an insurer is entitled to make reasonable enquiries to determine whether a claim is covered, and that making an insurance claim will inevitably involve some inconvenience. However, I agree that IPA could have provided a decision earlier than August 2025, and that this delay contributed to the inconvenience experienced. I therefore consider £250 to be a fair and reasonable amount of compensation for IPA’s service failings. In reaching this conclusion, I have also taken into account that even if IPA had explained the claims process more clearly and reached its decision sooner, Mr F and Ms R would still have had to wait until their daughter was fit to fly. Regardless of whether the claim was covered, they would have needed to extend their trip and, as a result, incur additional travel and accommodation costs. Even if IPA had declined the claim earlier, it is more likely than not that Mr F and Ms R would still have been required to remain abroad until their daughter was well enough to return home. I have a great deal of sympathy for the situation Mr F and Ms R found themselves in. And I can understand why they believe they should receive a more significant amount for the trouble and upset they’ve incurred. However, as an alternative dispute resolution service, our awards are lower than they might expect and probably less than a court might award. Overall, while I appreciate this will be disappointing for Mr F and Ms R, I’m satisfied that £250 appropriately reflects the distress and inconvenience caused by IPA’s handling of the claim. Putting things right I direct Inter Partner Assistance SA to pay Mr F and Ms R £250 compensation for the distress and inconvenience caused to them. It must do this within 28 days of the date on which we tell it Mr F and Ms R accept my final decision. If it takes longer, IPA must give them a meaningful update setting out the timeframe when they will make the payment. My final decision For the reasons given above, I partially uphold Mr F and Ms R’s complaint about Inter Partner Assistance SA.

-- 4 of 5 --

Under the rules of the Financial Ombudsman Service, I’m required to ask Mr F and Ms R to accept or reject my decision before 14 April 2026. Nimisha Radia Ombudsman

-- 5 of 5 --