Inter Partner Assistance SA · DRN-6213239

The complaint Mrs O and Mr O have complained that Inter Partner Assistance SA declined a claim they made under their travel insurance policy. What happened The background to this complaint is well known to the parties. In summary Mrs O and Mr O took out an annual multi trip travel insurance policy for themselves and two children in August 2024. The policy started in September 2024. Whilst on holiday in May 2025 Mrs O and Mr O's daughter, M, developed chicken pox and a doctor declared her unfit to fly. This meant they had to extend their holiday by two days and re-book their return flight home. IPA declined the claim. It said that had the questions been answered correctly at the sale stage it wouldn't have offered a policy. Unhappy, Mrs O and Mr O referred their complaint to our service. The investigator didn’t recommend that it be upheld. They didn’t find that IPA had given inconsistent advice or otherwise done anything wrong. Mrs O and Mr O appealed. All references to IPA in my decision include its authorised agents. 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. I’m aware I’ve summarised the background to this complaint and some sensitive medical details. No discourtesy is intended by this. Instead, I’ve focused on what I find are the key issues here. Our rules allow me to take this approach. It simply reflects the informal nature of our service as a free alternative to the courts. If there’s something I haven’t mentioned, it isn’t because I’ve ignored it. I’ve fully reviewed the complete file and Mrs O’s responses to the investigator’s view. Having done so I agree with the conclusion reached by our investigator. I’ll explain why. 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.

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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. During the sales process Mrs O and Mr O were asked the following question: Within the last two years has anyone you wish to insure on this policy suffered any medical condition (medical or psychological disease, sickness, condition, illness or injury) that has required prescribed medication (including repeat prescriptions) or treatment including surgery tests or investigations. Mrs O and Mr O answered ‘no’ to this question. IPA has said that the question was answered incorrectly with regard to M as within the two years prior to taking out the policy the medical records show that she had been seen by the doctor for medical conditions on four occasions and on one occasion had been prescribed medication. I fully appreciate Mrs O’s submission that these were minor conditions and not related to the claim subsequently made. But whether or not a consumer has taken reasonable care not to make a misrepresentation is to be determined in the light of all the relevant circumstances. CIDRA gives examples of things to be taken into account – one is how clear and how specific the insurer’s questions were. I’m satisfied that the question was unambiguous and clear. It set out in an easily understandable way information that IPA wanted to know in order to determine if it was a risk it was prepared to underwrite. The standard of care is that of a reasonable consumer. Mrs O submits that a reasonable parent could not realistically be expected to catalogue every viral episode during infancy. But I find that a reasonable consumer would have recognised that the insurer wanted to know about medical conditions and prescription medication in the previous two years for each person to be insured on the policy. Accordingly I don’t find that IPA’s conclusion that the question wasn’t answered with reasonable care was unfair given the medical evidence. IPA has shown that this policy wouldn’t have been offered to Mrs O and Mr O if the question had been answered correctly. It doesn’t follow, as Mrs O suggests, that infants are effectively uninsurable, just that this particular policy wouldn’t have been offered. Therefore I’m satisfied that the misrepresentation was a qualifying one. IPA offered to refund the premium paid to be refunded and the policy cancelled – this is in line with the remedies for careless misrepresentation under CIDRA. There is no suggestion that the misrepresentation was deliberate and it hasn’t been treated as such. I find that was fair. I don’t agree that IPA’s treatment of the claim is disproportionate or contrary to regulation or legislation. The regulatory rules also provide that insurers must handle claims promptly and fairly. Mrs O and Mr O have also complained that Mr O was given misleading advice regarding the claim. Both IPA’s adviser and the medical assistance line made clear what documents/evidence would need to be provided for the claim to be processed and that costs could be claimed back. I don’t find that there was any promise that the claim would be accepted so I’m not persuaded the information given was misleading. Finally reference has been made to other decisions this Service has made. I should point out that final decisions do not set any precedent. Each case is considered on its own circumstances and facts, as this has been. I am sorry that my decision doesn’t bring Mrs O and Mr O welcome news but for the reasons given I don’t find that IPA treated Mrs O and Mr O unfairly or unreasonably.

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My final decision My final decision is that I don’t uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mrs O and Mr O to accept or reject my decision before 24 April 2026. Lindsey Woloski Ombudsman

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