DRN-6263152

The complaint Mr and Mrs C complain because Admiral Insurance (Gibraltar) Limited hasn’t paid a claim under their travel insurance policy. What happened Mr and Mrs C and their children were insured under a travel insurance policy, provided by Admiral. Unfortunately, a close relative of Mrs C passed away, and the funeral was planned for a date when Mr and Mrs C were due to be on holiday. Mr C contacted Admiral to ask for information about the situation. Mr and Mrs C subsequently cancelled their holiday and made a claim with Admiral. Admiral said the claim wasn’t covered because of a policy exclusion relating to pre-existing medical conditions of close relatives. Unhappy, Mr and Mrs C complained to Admiral, who paid them £50 compensation for delays in addressing their complaint. However, Admiral maintained its stance that the claim wasn’t covered. Mr and Mrs C then brought the matter to the attention of our Service. Our Investigators looked into what had happened and said they didn’t think Admiral had acted unfairly or unreasonably in the circumstances. Mr and Mrs C didn’t agree with our Investigators’ opinions, so the complaint has now been referred to me to make a decision as the final stage in our process. 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 sorry to hear about the sad circumstances which led to this claim, and I’d like to offer Mr and Mrs C and their family my sincere condolences for their loss. Industry rules say insurers must handle claims fairly and shouldn’t unreasonably reject a claim. I’ve taken these rules, alongside other relevant considerations such as Consumer Duty principles, into account when making this final decision. The terms and conditions of Mr and Mrs C’s policy provide cover for the cancellation of a holiday in certain circumstances, including on the death of a close relative. However, this is subject to the following general exclusion: ‘We will not pay any claim which arises from or is directly or indirectly related to any of the following. 1. Pre-existing conditions:

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Any pre-existing condition that. … • a third party (such as a close relative…) had at any time before you took out or renewed your policy or booked a trip (whichever is later), regardless of whether you knew about the condition or not.’ An insurer is entitled to decide the level of risk it is prepared to accept in return for the payment of a premium. Travel insurers do not generally wish to and are under no obligation to insure what is generally considered to be a wide and uncertain risk relating to the medical conditions of non-travelling relatives. Exclusions like this one are found in most, if not all, travel insurance policies on the market. I don’t think the exclusion is unusual, and I’m satisfied the policy wording is clear. The exclusion is highlighted in the ‘Insurance: Product Information Document’ provided alongside this policy. The medical information which I’ve seen about Mrs C’s close relative says she unfortunately had a terminal prognosis and was receiving hospice care at the time Mr and Mrs C’s holiday was booked. This means Mr and Mrs C’s cancellation claim isn’t covered under the terms and conditions of their policy. I understand Mr and Mrs C couldn’t have known when Mrs C’s close relative would pass away, or when the funeral would be, and funeral arrangements could have been made across a number of weeks. However, Mr and Mrs C were aware that Mrs C’s close relative had a terminal prognosis at the time the holiday was booked. This isn’t a risk which Admiral is prepared to insure under this policy, regardless of any element of uncertainty surrounding exact dates or funeral arrangements. I don’t think there are any reasonable grounds upon which I could fairly direct Admiral to accept Mr and Mrs C’s claim outside of a strict application of the policy terms and conditions in these circumstances. I’ve considered the call which took place between Mr C and Admiral before the holiday was cancelled. I wouldn’t generally expect a travel insurer to give definitive confirmation of whether a claim will be covered during an initial enquiry call like this one. An insurer is entitled to make reasonable enquiries into the circumstances of a claim before confirming cover. Mr C was clearly told a claim could be considered but that it was too soon to confirm whether a claim would be covered. Mr C was advised to read his policy wording and to submit a claim. I don’t think this advice was unreasonable and its advice of the nature which I’d reasonably have expected Admiral to give in a situation like this one. Overall, I’m satisfied Admiral didn’t give any information during this call which was incorrect or misleading. Admiral’s comments that Mr C needed to cancel his trip cannot be considered in isolation and must be considered within the context of the entirety of the call. Admiral said Mr C would need to do this if he wanted to make a cancellation claim, in response to Mr C’s concerns about the holiday provider’s booking terms. It’s not reasonable to conclude this meant Admiral was advising Mr C that he must cancel the holiday. And I don’t agree with Mr C’s submissions that Admiral’s comments about cancelling the trip somehow override the very clear information he was previously given (that it was too soon to confirm whether a claim would be covered). In any event, even if I were to accept that Admiral had given Mr C inaccurate or misleading information, it wouldn’t necessarily follow that it would be fair and reasonable to hold it responsible for the cost of this claim anyway. If Mr and Mrs C had gone ahead with their holiday and returned early for the funeral as they are suggesting, then I think it’s more likely than not that they’d also have incurred costs to do this which wouldn’t have been covered under the policy either.

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I’m sorry to disappoint Mr and Mrs C. I’ve considered their complaint with sympathy, but I must reach an independent and impartial outcome which I think is fair and reasonable to both parties in the circumstances. I don’t think Admiral has acted unfairly or unreasonably so I won’t be directing it to do anything further. My final decision My final decision is that I don’t uphold Mr and Mrs C’s complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr and Mrs C to accept or reject my decision before 21 May 2026. Leah Nagle Ombudsman

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