DRN-6042649

The complaint Mr K complains that HELVETIA GLOBAL SOLUTIONS LTD (HGSL) unfairly declined a claim on his Tyre and Alloy Insurance policy. Amongst other things Mr K says that the policy contains contradictory wording and is in breach of the Consumer Duty1. The policy is branded in the name of the insurance intermediary that offers it. HGSL has appointed another insurance intermediary to handle claims on the policy. But, as HGSL is the policy underwriter it retains responsibility for claims and complaints about those. So, in this decision I will only refer to HGSL even where another firm has taken the actions described. What happened In 2022 Mr K took out a Tyre and Alloy Insurance policy. In August 2025 he made claims for damage to all four wheels on his car. HGSL said that Mr K’s policy only covered him for a maximum of three claims in a 12 month period. So it said it wouldn’t deal with one of the four claims. Mr K said that his policy entitled him to make up to nine claims in a three year period. So he thought that the policy terms were contradictory as HGSL wasn’t allowing him to do that. He brought his complaint to the Financial Ombudsman Service. One of our Investigators looked into it. The Investigator didn't think HGSL needed to take any further action. Mr K didn't agree so, as the matter remains unresolved, it’s been passed to me to determine. 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. In bringing this complaint and responding to our Investigator's assessment of it Mr K’s made many detailed points. I've carefully considered everything he's said but in this decision I don't intend to address each and every point raised. Instead I will focus on what I see as being the key issues at the heart of Mr K’s complaint and the reasons for my decision. Our rules allow me to take this approach. It simply reflects the nature of our service which is to resolve complaints with the minimum of formality. So, if there’s something I haven’t mentioned, it isn’t because I’ve ignored it. I haven’t. I’m satisfied I don’t need to comment on every individual argument to be able to reach what I think is the right outcome. Additionally, Mr K has referred to legal decisions and principles which he believes support his position. I’ve considered his submissions carefully. However, while we will take the law into account we are not bound by it. We are an alternative to the courts not a substitute for them. That means we don't make legal determinations. So I don't intend to refer to the legal principles or case law that Mr K has cited. Instead I will reach my decision on what I think is fair and reasonable in all the circumstances of the complaint. 1 The Consumer Duty is a regulatory requirement applicable to certain businesses regulated by the Financial Conduct Authority and is made up of rules and guidance.

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Further, I'm aware that Mr K has also raised concerns regarding HGSL’s handling of claims against his Scratch and Dent policy. However, I am not considering that here and will only be making a finding on Mr K’s complaint about his Tyre and Alloy policy. At the heart of Mr K’s complaint is what he believes is a contradiction in the policy wording. That is he believes the policy entitles him to make up to nine claims in a 36 month cover period. However, HGSL denied his fourth claim because it said he can only make three claims in a 12 month period. He says that both provisions can't coexist. While I understand the point that Mr K’s making I don't agree that there is any contradiction here. It’s extremely common for insurance policies to contain exclusions and limits on the cover they provide. In my experience all insurance policies set out both the policy benefits and exclusions. That’s the case here. Mr K’s policy will allow a maximum of three claims in a 12 month period. The policy allows a maximum of nine claims in a 36 month period, but there’s a limit as to the number of claims that can be made each year. The policyholder can make three claims a year for each of the three years the policy covers up to a total of nine. There is no contradiction here. I’ll add that the policy’s Insurance Product Information Document, which is a short document summarising the policies key benefits and exclusions twice sets out that the policy limits the cover to three claims a year. So I’m satisfied that is clear as to the limitations of the cover the policy provides. The policy wording itself does say that it may pay nine claims in a 36 month period on page two. But I don't think it’s reasonable to expect that term to be read in isolation without considering the other policy conditions. Insurance policies are not intended to cover each and every eventuality. And as I've already said all policies I'm aware of will set out their benefits and exclusions. In this case the exclusion of more than three claims in a 12 month period is set out on page three and again on page four. So, I'm satisfied that the policy clearly sets out that it limits its cover to three claims in a 12 month period up to a maximum of nine claims in a 36 month period. I don't find that a contradiction. And this is what Mr K agreed to when taking the policy out. The policy is also clear that Mr K needed to read and understand it. And if he found that it wasn’t suitable for his needs he could have cancelled it, with a full premium refund, within its 14 day cooling off period. But he didn't do so which means that he agreed to its terms and conditions. I'm aware that Mr K thinks the policy wording could be set out differently to make its exclusion clearer. But there are always numerous ways in which a policy could be drafted. The fact that a consumer my prefer one style to another doesn't make the insurer’s policy wording unreasonable or unclear. And, as I'm satisfied the policy intention is clearly set out I don't think there is anything untoward in the manner in which HGSL presents its exclusion. Similarly, I don't find that there is any requirement for the policy to explicitly say, as Mr K has argued, that the three claims per year does not ‘roll over’ to the next year. If it were the case that the three year limit did ‘roll over’, then the exclusion would only apply to the first year of the policy and would be rendered otherwise pointless. Further, I don't think the fact the policy doesn't define what it means by a ‘12 month period’ is relevant to Mr K’s claims. He made all four claims on the same day. So they were obviously made within the same 12 month period. Therefore, it’s not the case that any ambiguity, if indeed any arises – and for the avoidance of doubt I don't think it does – has affected HGSL’s decision to refuse his fourth claim. It’s also not the case, as Mr K has argued that the exclusion of more than three claims a year means that Mr K has lost out on 67% of his cover. Had his wheels suffered damage covered by the policy in the earlier years of its cover then he could have claimed at that point. The fact he didn't do so doesn't mean he’s lost out on cover. Insurance is exactly that, it provides cover for specific insured events. If no such insured event happens in the lifetime

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of a policy that simply means the policyholder has not had to make a claim not that they have lost out on cover. Further, Mr K believes that HGSL is in breach of the Consumer Duty. In complaints where the Consumer Duty is applicable, it may be a relevant consideration in deciding a fair and reasonable outcome. So I've thought carefully about whether there were any breaches of the Consumer Duty here. But I think the policy is clear, fair and not misleading and is designed in such a manner as to conform with Consumer Duty principles. So I’m satisfied no such breach occurred with regards to this policy. Mr K also thinks that, as he has two policies – the Tyre and Alloy policy and a Scratch and Dent policy – which share the same exclusion of three claims in a 12 month period, this is somehow evidence of “organisational failure to embed consumer duty”. However, as I'm satisfied that the wording in the Tyre and Alloy policy is clear I find no such organisational failure. For completeness I’ll add that Mr K said given the “complexity” of the matter he wished to speak with me before I reached my conclusions. But I don’t find the matter complex. And I don't think such a conversation is necessary or appropriate in order for me to understand the points involved here. I’m satisfied I have a good grasp of the issues, so I didn’t deem it necessary to speak with Mr K beforehand. In addition, when I’m looking at a complaint I will review all the evidence provided by both sides. We are generally a paper based organisation, and I would only usually talk to either side if I felt that there was evidence I could only collect by speaking to the individual or party directly. I don't think that’s the case here. And I don’t think it would be fair to give Mr K the opportunity to put his side of the argument to me personally without also offering HGSL the opportunity to do the same thing. But, in any event, I'm satisfied that I can consider the matter fairly and reasonably without speaking to either side. My final decision For the reasons set out above I do not uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr K to accept or reject my decision before 25 May 2026. Joe Scott Ombudsman

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