DRN-5939123

The complaint Mr G is unhappy with what Wakam did after he made a claim on his pet insurance policy. What happened At the end of February 2025 Mr G added a new cat (H) to his existing policy. He claimed on the policy at the end of May for treatment H received for dental work. Wakam turned down the claim. Initially it said the condition was present before the policy was taken out. It then accepted it couldn’t confirm that. But it thought H had shown symptoms of the condition in the 14 days after the policy was taken out. So it maintained its decision to decline the claim. It accepted Mr G had been inconvenienced by his claim being initially declined for the wrong reason and the time taken for it to be assessed. It paid him £100 in recognition of that. Our investigator reviewed H’s veterinary history and thought it likely the condition H was treated for (feline odontoclastic resorption lesion - FORL) was present within the first 14 days of cover. And the vet’s notes did identify issues with H’s teeth which he thought Mr G would have been aware of. He thought it was fair of Wakam to decline cover for the claim. And he thought the £100 compensation it had paid did enough to recognise the impact on Mr G of its claim handling failings. Mr G didn’t agree. He reiterated he wasn’t aware H had a pre-existing condition and she wasn’t his cat at the point issues with that were noted (and he didn’t have access to that information when he took the policy out). And he shouldn’t be expected to wait 14 days before taking H to the vet. So I need to reach a final 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 rules and industry guidelines say Wakam has a responsibility to handle claims promptly and fairly. It shouldn’t reject a claim unreasonably. Mr G’s policy includes cover for “dental treatment prescribed by your vet due to illness”. But the policy doesn’t pay claims for “any illness your pet suffers from in the first 14 days of the cover starting (including if your pet passes away)”. Illness is defined as “Any disease, sickness, signs or symptoms, or infection suffered by your pet”. The policy also excludes cover for “pre-existing conditions, except if your pet is covered under our pre-existing plan or the medical condition becomes eligible for cover at a later date.” Mr G says he wasn’t aware H had a pre-existing condition at the point he took the policy out (because she was a new cat to him and he didn’t have access to her previous veterinary history). But while Wakam did initially reference the pre-existing exclusion it subsequently accepted it couldn’t rely on that. Instead, it argued H suffered from the illness Mr G later claimed for within the first 14 days of cover starting. It’s that issue I need to consider when deciding whether it acted correctly and fairly in declining the claim Mr G made.

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The vet’s notes from 1 March 2025 include in H’s history “tartar teeth, chip off big lump”. Two days later an estimate is created for treatment which includes general anaesthetic, scale and polish and “+ / - 5 root extractions”. The estimate includes a drug used for pain relief following surgery. That suggests to me within the 14 day waiting period issues had been identified with H’s teeth which would meet the policy definition of illness and were likely to require further investigation and treatment. Mr G hasn’t suggested he was unaware of that. Notes from May 2025 then identify a history of dental problems affecting H including previous teeth extractions in 2020. And in response to a query from Wakam the current vet said there was a reference to “possible FORL” in H’s previous veterinary notes. And the dental work they had predominantly treated H for related to that. I haven’t seen evidence of an alternative cause for the issues which affected H in the waiting period. So I think it was reasonable of Wakam to conclude those were likely linked to the claim Mr G then made. And I think it acted correctly and fairly in relying on the policy exclusion for an illness a pet suffers from in the first 14 days of cover to decline his claim. Mr G says it wouldn’t be reasonable for him to have delayed taking H to the vet in the first 14 day. I agree with him it wouldn’t (and the policy says a policyholders responsibilities include not putting “your pet in risk or danger, neglect their health and safety, and/ or deliberately put them at risk”). But because an illness was identified in that period which was linked to his subsequent claim that means it isn’t covered by his policy. Wakam did initially rely on the pre-existing exclusion which it then accepted was incorrect. It’s also agreed there was some delay in its handling of the claim. I appreciate that will have caused Mr H some avoidable distress and inconvenience. But I think the £100 Wakam has now paid does enough to recognise the impact of that on him. My final decision I’ve decided not to uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr G to accept or reject my decision before 20 May 2026 James Park Ombudsman

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